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.
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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.
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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.
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Related to Utilization Review (UR)

  • Utilization review means the prospective (prior to), concurrent (during) or retrospective (after) review of any service to determine whether such service was properly authorized, constitutes a medically necessary service for purposes of benefit payment, and is a covered healthcare service under this plan. WE, US, and OUR means Blue Cross & Blue Shield of Rhode Island. WE, US, or OUR will have the same meaning whether italicized or not. YOU and YOUR means the subscriber or member enrolled for coverage under this agreement. YOU and YOUR will have the same meaning whether italicized or not.

  • Utilization review plan or "plan" means a written procedure for performing review.

  • Utilization review organization means an entity that conducts utilization review, other than a health carrier performing a review for its own health benefit plans.

  • Application Review Start Date means the later date of either the date on which the District issues its written notice that the Applicant has submitted a completed Application or the date on which the Comptroller issues its written notice that the Applicant has submitted a completed Application and as further identified in Section 2.3.A of this Agreement.

  • Asset Review Quorum In connection with any solicitation of votes to authorize an Asset Review as described in Section 11.01(a), the Holders of Certificates evidencing at least 5% of the aggregate Voting Rights represented by all of the Certificates.