Utilization Review Law and Legal Definition

Utilization review is the process of monitoring, evaluating medical necessity, use, delivery, cost-effectiveness, appropriateness, and the efficiency of the use of health care services provided by medical professionals on a prospective, concurrent, or retrospective basis.

The utilization review process compares requests for medical services with treatment guidelines and makes recommendation based on that comparison. The utilization review program applied to physicians and facilities are applied only to those claims that are adjudicated by the state fund. It helps to purchase proper and necessary care for injured workers.