Alabama Utilization Review Process

• Category: Alabama Workers Compensation - Official
• State: Alabama
• Control #: AL-031-WC
• Format: PDF

Description

Utilization Review Process The Alabama Utilization Review Process is a process used by the Alabama Medicaid program to ensure that the services its members receive are medically necessary and cost-effective. It is designed to ensure that healthcare services are appropriate to meet the medical needs of Medicaid members and that services are rendered in the most cost-effective manner. The Alabama Utilization Review Process includes pre-service review, concurrent review, retrospective review, and discharge planning. Pre-service review is a process that is done prior to the delivery of a service to determine if the service is medically necessary. This review is done to ensure that the service is within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested. Concurrent review is a process that is done during the delivery of a service to determine if the service is medically necessary and appropriate for the Medicaid member. This review is done to ensure that the service is within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested. Retrospective review is a process that is done after the delivery of a service to determine if the service was medically necessary and appropriate for the Medicaid member. This review is done to ensure that the service was within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested. Discharge planning is a process that is done prior to or at the time of discharge from a Medicaid provider's facility to determine the most appropriate post-discharge care for the Medicaid member. This review is done to ensure that the post-discharge care is within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested.

The Alabama Utilization Review Process is a process used by the Alabama Medicaid program to ensure that the services its members receive are medically necessary and cost-effective. It is designed to ensure that healthcare services are appropriate to meet the medical needs of Medicaid members and that services are rendered in the most cost-effective manner. The Alabama Utilization Review Process includes pre-service review, concurrent review, retrospective review, and discharge planning. Pre-service review is a process that is done prior to the delivery of a service to determine if the service is medically necessary. This review is done to ensure that the service is within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested. Concurrent review is a process that is done during the delivery of a service to determine if the service is medically necessary and appropriate for the Medicaid member. This review is done to ensure that the service is within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested. Retrospective review is a process that is done after the delivery of a service to determine if the service was medically necessary and appropriate for the Medicaid member. This review is done to ensure that the service was within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested. Discharge planning is a process that is done prior to or at the time of discharge from a Medicaid provider's facility to determine the most appropriate post-discharge care for the Medicaid member. This review is done to ensure that the post-discharge care is within the scope of the Alabama Medicaid program and meets the medical necessity criteria for the service requested.