Utilization Review is the process insurance companies use to approve, authorize or decline services. The purpose of the Utilization Review process is to screen, and approve the “least-restrictive” clinical services on a peer case basis. The reason insurance carriers use this process is to standardize approval criteria - to only pay for services deemed medically necessary.
This is a very critical step. Often overlooked or disregarded, improper and/or poorly managed Utilization Review could limit profitability as well as a client’s length of treatment.