A recent opinion from the Commonwealth Court of Pennsylvania has changed the rules for Utilization Review and thrown open the doors to a new class of litigants. In Keystone Rx, LLC v. AmeriHealth (Fee ...
Healthcare organizations across the country should train their attention on a federal court case pending in Georgia that deals squarely with whether RNs performing utilization review (UR) work are ...
Concurrent review is a utilization review process that occurs while a patient is actively receiving treatment, such as during a hospital stay. It evaluates the medical necessity and appropriateness of ...
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