Utilization Review
/ˌjuːtɪləˈzeɪʃən rɪˈvjuː/
Definitions
- (n.) A process whereby a third-party payer or insurer reviews the medical necessity, appropriateness, and efficiency of healthcare services provided to patients.
The insurance company conducted a utilization review before approving the surgery.
Forms
- utilization review
- utilization reviews
Related terms
See also
Commentary
Utilization review often involves criteria set by insurers or regulatory bodies and can impact coverage decisions and payment; drafters should distinguish it from peer review, which focuses on clinical quality rather than cost or necessity.
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.