utilization review


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Related to utilization review: Drug Utilization Review

utilization review

n.
A process for monitoring the use and delivery of services, especially one used by a managed care provider to control health care costs.
References in periodicals archive ?
If either party is displeased with the utilization review determination, a hearing can be requested, and the matter is assigned to a workers' compensation judge.
Genex CEO and president Peter Madeja said, "Integrating CID's utilization review
Pharmacists managing the programs should take proactive measures to expand utilization review programs as changes in the workers' compensation industry evolve.
By putting a drug utilization review program into place, auto no-fault insurers could receive significant incremental savings--usually between 10% and 15% above the prescription cost savings.
Without true utilization review, you have a "time-lapse" disconnect.
A licensed Ontario pharmacist, Ivey has been an associate owner of a community pharmacy, as well as involved in drug evaluation and utilization review initiatives.
It includes cases studies, best practices and strategies for handling patients and physicians, discharge planning, utilization review and related management operations.
Medco Health's senior drug utilization review (SDUR) system issued 7.9 million medication alerts in 2002: 2.2 million for prescriptions exceeding the clinically recommended dose for a senior age 65 and older, 2.4 million for drugs that are clinically inappropriate for the elderly and could lead to harm, and more than 3 million for interactions between two or more medications.
The term "utilization review" refers to the process the HMO or its agents use when deciding whether to approve or deny care to a plan member.
For one thing, more managed care plans have loosened their utilization review requirements in the past few years, making it easier for patients to visit specialists without preapprovals.
resource power, which is gained by having control over a critical resource that is essential to the functioning of the organization, is in short supply, or cannot be substituted--for example, providing utilization review for third-party payer reimbursement.
Further research is needed to definitively elucidate any relationship that might exist between utilization review decisions and quality of care.