Programs designed to reduce unnecessary or inappropriate medical services, both inpatient and outpatient. Utilization reviews may be prospective, retrospective, concurrent, or in relation to discharge planning.

The review process aimed at helping HMOs and insurance companies reduce health care costs by avoiding unnecessary care. The review includes evaluating requests for medical treatment and determining, on a case-by-case basis, whether that treatment is necessary.

A system that examines the distribution of treatment procedures based on claims information and in order to be reasonably reliable, the application of such claims analyses of specific dentists should [..]

A technique for controlling medical expenses by reviewing utilization patterns reflected in claims information. Types of, quantities of, and charges for medical services are evaluated to identify pr [..]

The determination of the medical necessity and appropriateness of health services by someone other than your attending provider.

An evaluation of the medical necessity, appropriateness, and cost-effectiveness of healthcare services and treatment plans for a given patient. (back to top)

An organized procedure to review admissions, duration of stay, and professional, pharmacologic or programmatic services provided, and to evaluate the need for those services and promote their most efficient use.

The evaluation of medical necessity, efficiency or quality of health cares services, prospectively, concurrently, or retrospectively. The term utilization review is more limited to the physician' [..]

an official review of the need and quality of services rendered inside a hospital or clinic or via an individual care provider. Conducted by a specially-appointed team, a utilization review frequently [..]

A cost-containment measure used by health care insurers, third-party administrators and others to evaluate the need for treatment and assess alternatives to expensive or complex procedures. Among the techniques used are preadmission certification, solicitation of second opinions and use of rehabilitation programs. Evaluation of the use of hospital [..]

Utilization review is the process of monitoring, evaluating medical necessity, use, delivery, cost-effectiveness, appropriateness, and the efficiency of the use of health care services provided by med [..]

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 [..]

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 usuall [..]

This is a process of tracking, reviewing and rendering opinions about care. The practices of pre-certification, recertification, retrospective review and concurrent review all describe utilization rev [..]

See   Medical utilization review

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 [..]

A health insurance company’s review to determine if the health care services a provider or facility gives to a member or group of members is necessary and appropriate.

An investigation or audit performed to optimize the number of inpatient and outpatient services a provider performs.

A safeguard for health plans against unnecessary or inappropriate care.

A cost control mechanism by which the appropriateness, necessity, and quality of health care services are monitored by insurers, HMOs and employers.

The practice of looking at the treatment patterns of particular providers to see how their usage of drugs, X-rays, lab tests, and other services compares with their peers. HMOs use utilization review [..]

See Medical utilization review

Review or audit conducted to reduce unnecessary inpatient or outpatient medical services or procedures.

The assessment of treatment in accordance with guidelines and standards that are established and accepted by health care professionals using medical necessity criteria. The assessment occurs before an [..]

Hospital staff who work with doctors to determine whether you can get care at a lower cost or as an outpatient.

The process used by insurance companies to decide whether to authorize and pay for treatment recommended by your treating physician or another doctor.

See Medical utilization review

See Medical utilization review

A cost-control mechanism by which the appropriateness, necessity and quality of health care is monitored by both insurers and employers.

"Utilization review" means a set of formal techniques used by an insurer or delegated by the insurer designed to monitor the use of or evaluate the medical necessity, appropriateness, effica [..]

(US,medicine|management) A review of the use of medical resources at a medical facility for purposes of cost control.