Glossary
Tags
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Utilization Management
A process used by health insurance providers to evaluate the necessity and efficiency of healthcare services. It includes practices like prior authorization, step therapy, and case reviews to ensure appropriate use of medical resources. Common in Medicare Advantage, Medicaid, and ACA plans.
A process used by health insurance providers to evaluate the necessity and efficiency of healthcare services. It includes practices like prior authorization, step therapy, and case reviews to ensure appropriate use of medical resources. Common in Medicare Advantage, Medicaid, and ACA plans.