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Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
Drug utilization review acted as a background paper written by the United States Department of Health, Education, and Welfare task force. This task force considered that drug utilization review was potential but this review should be evaluated and need valid evidence to put into effect. [7]
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
URAC's accreditation programs include specialty pharmacy, digital health, utilization management, health plan, case management, and others. [4] In order to earn an accreditation, organizations submit various policies and procedures which are reviewed by a nurse or pharmacist and then the Accreditation Committee. [5] Accreditation lasts for ...
Listen and subscribe to Decoding Retirement on Apple Podcasts, Spotify, or wherever you find your favorite podcasts. Social Security isn’t going bankrupt, but challenges lie ahead. The Social ...
Utilization and Relative Resource Use; Health Plan Descriptive Information; Measures Collected Using Electronic Clinical Data Systems; Measures are added, deleted, and revised annually. For example, a measure for the length of stay after giving birth was deleted after legislation mandating minimum length of stay rendered this measure nearly ...
A parent whose daughter plays high school basketball recently reached out to me. This person had revisited my October 2023 article on the troubling conduct of parents at youth and high school ...
It’s illegal to sell or buy, but casu marzu, a maggot-infested sheep milk cheese is a revered delicacy on the Italian island of Sardinia. Locals hope their unusual dairy product can shed its ...