Managed Care Organizations: Utilization Analysis

Utilization review incorporates within the process a third-party payer who would analysis, and then determine the medical necessity of a course of action, or treatment plans. Managed Care Organizations from my understanding would utilize utilization review process in order to compare a patient’s request for care with what treatment options physicians would generally practice under similar medical circumstances.
As previously mentioned at the start of this week’s discussion, utilization review has three specific and defined categories. Research highlighted that most Managed Care Organizations, and insurance companies place reliance on prospective and concurrent utilization reviews to evaluate whether care is necessary.
Case management, utilization