Professional
Technical
In the Industry Vocabulary Test
utilization review
Systematic evaluation of medical necessity and appropriateness of psychiatric treatment services for insurance coverage.
Full Definition
Utilization review is the systematic evaluation process conducted by insurance companies or healthcare organizations to determine the medical necessity, appropriateness, and cost-effectiveness of psychiatric treatment services. The review examines treatment plans, progress notes, diagnostic justification, and clinical outcomes to approve or deny coverage for specific levels of care. Clinical staff must provide detailed documentation supporting continued treatment need and demonstrate progress toward measurable goals.
Usage
Usage note: Write as two words, not hyphenated, when used as a noun phrase.
In Context
- "Utilization review approved continued partial hospitalization for another two weeks based on documented clinical progress." — Insurance authorization
- "The utilization review nurse requested additional documentation to support the requested intensive outpatient services." — Clinical correspondence
Also known as
UR
medical necessity review
Don't confuse with
quality assurance
peer review