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What is Utilization review (UR)?

April 26, 2017review UR utilization

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What is Utilization review (UR)?

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The utilization review process compares requests for medical services (“utilization”) to treatment guidelines that are deemed appropriate for such services and includes the preparation of a recommendation based on that comparison. The Utilization Review Program applies only to claims that are adjudicated by the State Fund. The program applies to both physicians and facilities. L&I contracts with Qualis Health for Utilization Review.