How to Find a Utilization Review Organization

Locate a utilization review organization using Internet research.

An organization that reviews cases after health care services are provided to the customer is considered a utilization review organization, according to the URAC, previously known as the Utilization Review Accreditation Commission. Utilization management uses utilization review to evaluate medical necessity and appropriateness of health care services according to a particular health care plan. It is important to understand the difference between the two terms before looking for a utilization review organization. Modern terminology encompasses both utilization review and utilization management under the generic term of utilization review.

Things You'll Need

• Computer with Internet connection

Instructions

Internet

1. Open the browser on your Internet.

2. Type "utilization review organization" and the name of your state, for example, "utilization review organization illinois." Click on go or search.

3. Review the page resulting from your search and click on the desired links.

4. Complete a second search of the Internet. Type URAC in the search box. Click go or search.

5. Look at the URAC homepage and locate the box under Accreditation Directory. Type in the name of your health care plan or the name of a health care plan you are considering. Click search to see if the plan is accredited.

State Capital

1. Locate the phone number of the state health department or the state governmental department designated to oversee health care.

2. Call the health department. Ask to speak to an individual in charge of Utilization Review Organizations.

3. Ask the individual what organizations are available within your state.

References

• Managed Healthcare Executive: Understand the Nuances of Utilization Review and Utilization Mangement
• URAC