Utilization review ensures medical care is used correctly and efficiently. Nurses often perform utilization reviews and coordinate with health plans. You can appeal a decision if your health plan ...

Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...

The California Supreme Court will weigh in on a lower court decision that would have a chilling effect on the state’s workers compensation medical treatment approval process and expand potential ...

The secrets are to think like a reviewer, hone your documentation skills and be a good communicator, says this FP who’s seen both sides of UR. For the last 10 years, I’ve been on both sides of ...

California is among a handful of states that seeks to regulate the use of artificial intelligence (“AI”) in connection with utilization review in the managed care space. SB 1120, sponsored by the ...

In Pennsylvania, if an insurer contends that a medical service, drug or device is unnecessary, it must resolve the dispute through a process called utilization review, where medical professionals ...

AnMed, a nonprofit health system serving residents of upstate South Carolina and Georgia, will leverage XSOLIS’ artificial intelligence (AI) and machine learning (ML) tools to drive greater clinical ...

Pennsylvania lawmakers have filed legislation that would require insurers to disclose when artificial intelligence is used during the utilization review process. House Bill 1663, filed Thursday, would ...

Utilization management has long lived inside the EMR by default, not by design. For many health systems, that means physician advisors and UR nurses work from different views of the same patient, ...

Join Goldberg Segalla partner Natasa Timotijevic for an in-depth discussion focusing on Illinois’ sweeping changes regarding how Utilization Review and Independent ...