What does UR stand for in the context of utilization management?

• A. Utilization Review
• B. Unrelated Review
• C. User Retroactivity
• D. Unified Review

Answer: (A)

Utilization Review is the process used in utilization management to assess whether a requested service or course of treatment is medically necessary, appropriate, and efficient for the patient’s diagnosis and plan benefits. This can happen before care (precertification or prior authorization), during care (concurrent review, such as a hospital stay), or after care (retrospective review). By applying evidence-based guidelines and criteria, UR helps ensure that services provided are appropriate and that resources are used wisely, which is a core goal of utilization management in self-insured plans. The other terms listed aren’t standard concepts in this context.