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 ...

The effects of anonymity on utilization review has never been examined in the real world. This study aimed to evaluate the impact of removing anonymity protection for claims reviewers on their review ...

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both ...

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...

PLEASANTON, Calif.--(BUSINESS WIRE)--State Fund announced today that it will soon launch a revolutionary utilization review (UR) technology called UR Connected. The system will dramatically speed up ...

Kanika Kapur is an associate economist at RAND in Santa Monica, California. Carole Roan Gresenz is an economist at RAND in Arlington, Virginia. David Studdert is an assistant professor of law and ...

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 ...

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the ...