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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.
Retrospective drug utilization review refers to drug therapy review that after patients have got the medication. [10] The retrospective drug utilization review has a typical process. [12] This is a computer based review. Computer will show data which are in violation of the standard.
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 ...
The process reviews a patient's drug order in a systemic and comprehensive review against predetermined criteria and compared against a patient’s or a population’s data records. The DUR process often utilizes computerized algorithms to perform key checks with known data, and the results of the algorithms are reviewed by the pharmacist.
An independent medical review (IMR) is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. Peer review also is used in order to define the review of sentinel events in a hospital environment for quality ...
Bring your credit utilization as low as possible and pay off any small lingering balances. Quick tip: As you review your credit report, look for accounts with high interest rates.
Image source: The Motley Fool. Lam Research (NASDAQ: LRCX) Q4 2024 Earnings Call Jan 29, 2025, 5:00 p.m. ET. Contents: Prepared Remarks. Questions and Answers. Call ...
Clinical peer review, also known as medical peer review is the process by which health care professionals, including those in nursing and pharmacy, evaluate each other's clinical performance. [ 1 ] [ 2 ] A discipline-specific process may be referenced accordingly (e.g., physician peer review , nursing peer review ).