Utilization management definition

Utilization management section means “you or your authorized representative.” Your representative will also receive all notices and benefit determinations.

Utilization management means a system for reviewing the

Utilization management means a set of formal techniques designed to monitor the

Examples of Utilization management in a sentence

• Utilization management decisions are based only on appropriateness of care and service.

• Utilization management may be referred to as Medical Necessity reviews, utilization review (UR), or medical management reviews.

• Utilization management of covered services is a part of the assurance of medically necessary service provision.

• Utilization management data provide the basis for decisions on the re-distribution of state services resources in accordance with the state priorities for these resources and to assure efficient use of these limited resources.

• Utilization management processes are applied to ensure the medical necessity and cost- effectiveness of MH/SUD and M/S benefits.• Prior authorization for prescription drugs: Prior authorization is a process used to determine if coverage of a particular drug will be authorized.• Provider admission requirements: Provider admission criteria may impose limits on providers seeking to participate in a CCO’s network.

More Definitions of Utilization management

Utilization management means a set of formal techniques designed to monitor the use of, or evaluate the medical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings.

Utilization management means the evaluation of medical necessity and appropriateness of the use of health care services, procedures, and facilities utilized by a Covered Person under the terms of the Plan.

Utilization management means a system for reviewing the appropriate and efficient allocation of health care services under a health benefits plan according to specified guidelines, in order to recommend or determine whether, or to what extent, a health care service given or proposed to be given to a covered person should or will be reimbursed, covered, paid for, or otherwise provided under the plan. The system may include preadmission certification, the application of practice guidelines, continued stay review, discharge planning, preauthorization of ambulatory care procedures, and retrospective review.

Utilization management means a system for administering some or all of an insurer’s decision point review plan, including but not limited to, receiving and responding to decision point review and precertification requests, making determination of medical necessity, scheduling and performing independent medical examinations (IMEs) bill review and handling of provider appeals.

Utilization management means a system for reviewing the appropriate and

Utilization management. The process of evaluating the necessity, appropriateness and efficiency of health care services against established guidelines and criteria.

Utilization management means a set of formal