The utilization review process is designed to help hospitals determine the appropriate level of care and care setting for patients based on medical necessity. While this process is an expense for ...

As most workers' compensation practitioners are aware, the utilization review process was one of the main aspects of the medical cost containment provisions of the 1993 amendments to the Workers' ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...

The utilization review process, in which an employer may challenge the reasonableness or necessity of the medical treatment of an injured employee, was at issue in County of Allegheny (John J. Kane ...

Q: Do you have any suggestions on how to make the Utilization Review and Triple Check processes more efficient? A: Implementing a robust Utilization Review and Triple Check process serves several ...

NEW YORK--(BUSINESS WIRE)--VirtualHealth, provider of HELIOS, the leading SaaS care management platform, today announced the launch of a fully integrated, ground-breaking utilization management ...

Case management, with its standards of practice of patient advocacy and resource stewardship and its role as a liaison between patients, payors and the healthcare team, is in a unique position to ...

I need to do a drug utilization evaluation (DUE) for a new product to be added to our formulary. What resources are available to develop a DUE? The formulary system encompasses facets of medication ...