When it comes to utilization management (UM) – the evaluation of the medical necessity, appropriateness, efficacy and efficiency of the use of healthcare services, procedures and facilities under the provisions of the applicable health benefits plan – medical facilities are faced with a growing number of questions and challenges. Utilization of hospital services usually accounts for up to 40% or more of the total expenses in a managed care plan. That amount can be even greater when utilization is excessive. With hospitals constantly seeking ways to save money while becoming more efficient, utilization management is particularly a necessary requirement.

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