What is the main purpose of the utilization review process?

The main purpose of the utilization review process is to assess the necessity and efficiency of services provided. This process involves evaluating the appropriateness of a patient's medical treatment, ensuring that the services rendered are necessary for the patient's condition and that they meet the standards of care within the healthcare system. Utilization review plays a critical role in maintaining quality control, improving patient care, and managing healthcare costs by identifying unnecessary procedures, reducing inappropriate admissions, and streamlining the delivery of healthcare services.

By focusing on the necessity and efficiency of care, utilization review helps ensure that patients receive the right level of care at the right time, ultimately contributing to better health outcomes and optimized resource allocation within healthcare facilities. This is fundamental for both patient safety and the sustainable operation of healthcare organizations.