Medical Utilization Review
/ˈmɛdɪkəl ˌjuːtəlaɪˈzeɪʃən rɪˈvjuː/
Definitions
- (n.) A systematic process conducted by health insurers or third-party reviewers to assess the necessity, appropriateness, and efficiency of healthcare services provided to a patient, typically to control costs and ensure compliance with coverage terms.
The insurer denied the claim following a medical utilization review that found the procedure was not medically necessary.
Forms
- medical utilization review
- medical utilization reviews
Related terms
See also
Commentary
Commonly performed prior to payment authorization; precise definitions and procedures vary by jurisdiction and insurer policy.
This glossary is for general informational and educational purposes only. Definitions are jurisdiction-agnostic but reflect terminology and concepts primarily drawn from English and American legal traditions. Nothing herein constitutes legal advice or creates a lawyer-client relationship. Users should consult qualified counsel for advice on specific matters or jurisdictions.