Utilization Management

Excerpt

Utilization Management (UM), initially referred to as Utilization Review (UR), remains a well-recognized component of a cost management approach in the health care service delivery and payment arenas. UM processes include interventions that take place before, during, and after the clinical encounter. The type of UM that occurs before the clinical event is called prior authorization or "pre-auth." If UM occurs during clinical care for a patient admitted to a facility, then this type of UM is called a concurrent review. Finally, UM that is done after the clinical encounter has occurred is called the retrospective review or "retro-review."