What term refers to the payer's process for determining medical necessity?
A) utilization review
B) audit
C) acceptance
D) stop-loss provision

Question

Quizplus · Accepted Answer

Utilization review is the process used by insurance payers to review and determine the necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. This process ensures that patients receive necessary care without undergoing unnecessary or overly expensive treatments.

What Term Refers to the Payer's Process for Determining Medical