AHIP AHM-250 Exam - Topic 7 Question 135 Discussion

Question

The data evaluation stage of utilization review (UR) includes both administrative reviews and medical reviews. One true statement about these types of reviews is that:

Grover · Accepted Answer

D) One purpose of a medical review is to evaluate the medical necessity of a proposed medical service.

Grover · Answer

A) An administrative review must be conducted by a health plan staff member who is a medical professional.

Grover · Answer

B) The primary purpose of an administrative review is to evaluate the appropriateness of a proposed medical service.

Grover · Answer

C) UR staff members typically conduct a medical review of a proposed medical service before they conduct an administrative review for that same service.