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Related to utilization review: Drug Utilization Review
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It is important not to confuse retrospective utilization review with fraud detection.
Admission denials were obtained from utilization review data.
The three-year project became operational in June and provides on- line prospective drug utilization review for 100 pharmacies throughout Iowa.
Pinell recommends that aspiring physician executives seek out medical directors as mentors and serve on committees, such as utilization review, risk management, and quality improvement.
Serbaroll states that: adverse outcomes attributable to utilization review determinations of care will certainly be a fertile ground for lawsuits.
In addition, Admar provides national Preferred Provider and Exclusive Provider Organizations, utilization review management and administrative services.
The standards ensure that appropriately trained, qualified clinical personnel conduct and oversee the utilization review process, that a reasonable and timely appeals process is in place, and that medical decisions are based on valid clinical criteria.
Shortly after I assumed the role of Medical Director for the Health Centers in April 1990, the HMO Blue organization put together a committee to revise and update its Quality Assurance and Utilization Review Manual.
NDC will license its ProDUR(R) real-time prospective drug utilization review (DUR) system to Unisys Government Services, fiscal agent for the Iowa Medicaid Program.