Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality
Utilization Review -- Congresses -- United States : Redesigning the clinical effectiveness research paradigm : innovation and practice-based approaches : workshop summary / LeighAnne Olsen and J. Michael McGinnis, editors ; Institute of Medicine of the National Academies
Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993
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Utilization Review -- economics : Controlling costs and changing patient care? : the role of utilization management / Institute of Medicine, Division of Health Care Services, Committee on Utilization Management by Third Parties ; Marilyn J. Field and Bradford H. Gray, editors
An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use
Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993
