Utilization Review
A process used by insurance companies to evaluate the appropriateness, medical necessity, and efficiency of health care services.
Detailed Explanation
This process helps ensure that patients receive the right care at the right time and in the most cost-effective setting.
Practical Example
Before approving a request for a lengthy hospital stay, Michael's insurance company conducted a utilization review to ensure that the level of care was medically necessary and appropriate for his condition.
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