Utilization Review (UR) definition

Utilization Review (UR) means the process of reviewing, evaluating, and assuring appropriate use of medical resources and services. The review encompasses quality, quantity, and appropriateness of medical care to achieve the most effective and economic use of health care services.

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Utilization Review (UR) means the evaluation of the appropriateness, necessity, and quality of services billed to Medicaid. It also means the evaluation of the use of Medicaid services by recipients, including a recipient's need for continued stay in an institutional care facility.

Utilization Review (UR) means a system for reviewing the appropriate and efficient allocation of health care services or level of care given or proposed to be given to a recipient.

Examples of Utilization Review (UR) in a sentence

ADMINISTRATOR may conduct a Utilization Review (UR) at CONTRACTOR’S facility referenced in Paragraph 7 of this Exhibit, with date and time determined at ADMINISTRATOR’S discretion.
Attendance at scheduled Children's Mental Health Utilization Review (UR) meetings is required.
Be responsible for the provision of medical Utilization Review (UR) services.
The appropriateness of inpatient admissions and inpatient length of stay shall be monitored on a case-by- case basis through the PROVIDER’s Utilization Review (UR) Program.
ADMINISTRATOR may conduct a Utilization Review (UR) at CONTRACTOR’s facility referenced in Paragraph 13 of this Attachment A, with date and time determined at ADMINISTRATOR’s discretion.
The appropriateness of inpatient admissions and inpatient length of stay shall be monitored on a case-by-case basis through the PROVIDER’s Utilization Review (UR) Program.
CONTRACTOR shall have all records pertaining to SSA CLIENTS at their facility at the scheduled time of each Utilization Review (UR).
Attendance at scheduled Children’s Mental Health Utilization Review (UR) meetings is required.
Utilization Review (UR): Evaluation of the clinical necessity, appropriateness, efficacy, or efficiency of Health Care services, procedures or settings, and ambulatory review, prospective review, concurrent review, second opinions, care management, discharge planning, or retrospective review.
This is a fixed fee Contract between County and Contractor for Managed Care Services – Bill Review (BR), Utilization Review (UR), Nurse Case Management (NCM) and Pharmacy Benefits Management (PBM) for the County’s Workers’ Compensation Claims Program as set forth in Attachment A, Scope of Work.

More Definitions of Utilization Review (UR)

Utilization Review (UR) means the system for retrospective, concurrent, or prospective review of the medical necessity and appropriateness of Healthcare Services provided, being provided, or proposed to be provided to a Member. The term does not include elective requests for clarification of coverage. Utilization Review Accreditation Commission dba American Accreditation HealthCare Commission, Inc. (URAC) means an independent, nonprofit accreditation entity that accredits health plans, case management and DM programs, pharmacy quality management programs as well as provider integration and coordination programs to increase healthcare quality.