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

• A person who has the ability to pay a forfeiture entered pursuant to this ordinance, but who fails or refuses to do so may be confined in the county jail until the forfeiture and costs are paid, but the period of confinement may not exceed 30 days.

• Utilization management decision making is based only on appropriateness of care and service and existence of coverage.

• The following staff members shall receive additional training specific to the Hoosier Healthwise program and their roles: Utilization management staff shall receive ongoing training regarding interpretation and application of the Contractor’s utilization management guidelines.

• That this could also be the case in Anglo-Saxon England is demonstrated by the burning of the minster church at Ripon, part of the estate of the Archbishop of York, by King Eadred in 948 due to the Northumbrians choosing Erik (alias Bloodaxe) as king.112 In northern Northumbria churches closely aligned to the Archbishop of York or the Community of St Cuthbert may have been seen as legitimate targets by Strathclyde Britons and Scots trying to expand their territory south.

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 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 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 set of formal

Utilization management or “UM” 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 Member should or will be reimbursed, covered, paid for, or otherwise provided under the Plan. The system may include: pre-admission certification, the application of practice guidelines, continued stay review, discharge planning, pre-authorization of ambulatory care procedures, and retrospective review.