YOU ASK:

What is the definition of Medical Utilization Review?

WE ANSWER:

Medical Utilization Review is used for health insurance products and is a process where claims for medical treatment are reviewed.

The Medical Utilization Review is usually done by a medical practitioner (like a nurse or a doctor) to verify whether the treatments and services received were reasonable and applicable. This is part of the efforts of insurance companies to protect themselves from claims fraud and also to manage costs and keep premium rates on these products at a low level.

Another purpose of the medical utilization review is to ensure the quality of care a client gets.

Based on these goals, the reviewer looks at a treatment plan and may modify, delay, approve or deny treatment recommendations.

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