Utilization review provides an assessment on the delivery of medical services to determine if the care provided is appropriate, medically necessary, and of high quality. Utilization reviews may include review of appropriateness of admissions, services ordered and provided, length of stay, and discharge practices, both on a concurrent and retrospective basis.
The process involves medical records abstracting, analysis and documentation of certification, non-certification and modification of requests based on ACOEM Guidelines and evidence-based medicine. Reports are accurate, complete with comprehensive supporting evidence, guidelines and/or research.
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