Utilization Review (UR), also known as utilization management, is a service through Hometown Health Partners Benefit Administrators that reviews the effectiveness and quality of your health care. Through utilization review, we work with our providers to identify the most appropriate medical care. This comprehensive program involves our entire health care team.
Our UR services consist of three components:
- Certification and Precertification
- Concurrent Review
- Retrospective Review
The certification and precertification process ensures that hospital admissions and other medical services are appropriate. We use nationally recognized and approved criteria designed to determine medical necessary and appropriate.
Concurrent review ensures that a patient's hospital stay is appropriate and no longer than necessary. In addition, we review continuing treatments to ensure they are appropriate and show progress for the patient.
We perform retrospective reviews to assess trends and patterns of resource utilization and patient outcome. Then we use the results to prevent unnecessary costs or procedures in the future.
For more information on Hometown Health's products and services, please contact your Hometown Health Account Executive.
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