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Utilization review

A formal assessment of the medical necessity, efficiency, or appropriateness of health care services and treatment plans on a prospective, concurrent, or retrospective basis (United HealthCare Corporation, 1994, p. 74).

REFERENCES

EAPA (Employee Assistance Professional Association). 1995. Glossary of Employee Assistance Terminology. Arlington, VA: Employee Assistance Professional Association, Inc.

IOM (Institute of Medicine) . 1989. Controlling Costs and Changing Patient Care: The Role of Utilization Management. Washington, DC: National Academy Press.

IOM. 1990a. Clinical Practice Guidelines: Directions for a New Program Washington, DC: National Academy Press.

IOM. 1990b. Medicare: A Strategy for Quality Assurance. Washington, DC: National Academy Press.

JCAHO (Joint Commission on Accreditation of Healthcare Organizations) . 1989. Managed Care Standards Manual. Chicago, IL: Joint Commission on Accreditation of Healthcare Organizations.

JCAHO. 1996. 1996 Comprehensive Accreditation Manual for Health Care Networks. Chicago, IL: Joint Commission on Accreditation of Healthcare Organizations.

NCQA. (National Committee for Quality Assurance) . 1995. Standards for Accreditation, 1995. Washington, DC: National Committee for Quality Assurance.

United HealthCare Corporation. 1994. The Managed Care Resource: The Language of Managed Health Care and Organized Health Care Systems. Minneapolis, MN: United HealthCare Corporation.



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