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Health Care > Utilization Review, Non-Delegated
The following information is about Utilization Review, Non-Delegated.
Utilization Review, Non-Delegated Defined
An entity external to the hospital under contract to the payer to review services provided a specific covered population operates a separate UR system, using its own norms, criteria and standards and relies upon its own personnel to obtain clinical information. It may use information obtained from clinicians, the patient, family, medical records, or claims information submitted for payment after patient discharge. It may be conducted concurrently or retrospectively, in person or the hospital premises, or by telephone, or by review of documentation.
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