Health Care Utilization Review Forms for Fairfax

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FAQ

There are three activities within the utilization review process: prospective, concurrent and retrospective. Prospective review includes the review of medical necessity for the performance of services or scheduled procedures before admission.

Utilization Management (UM) is a series of integrated processes that help to ensure that treatment is medically necessary as required by the member's contract.

A utilization review is a process in which a patient's care plan undergoes evaluation, typically for inpatient services on a case-by-case basis. The review determines the medical necessity of procedures and might make recommendations for alternative care or treatment.

Utilization review is the process of making sure healthcare services are being used appropriately and efficiently, which is a key component of a value-based approach to paying for health care.

Utilization review contains three types of assessments: prospective, concurrent, and retrospective.

While utilization review identifies and addresses service metrics that lie outside the defined scope, while utilization management ensures healthcare systems continuously improve and deliver appropriate levels of care.