Câu 33: AHM-250: Healthcare Management: An Introduction

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:

1. A. An administrative review must be conducted by a health plan staff member who is a medical professional.
2. B. The primary purpose of an administrative review is to evaluate the appropriateness of a proposed medical service.
3. C. UR staff members typically conduct a medical review of a proposed medical service before they conduct an administrative review for that same service.
4. D. One purpose of a medical review is to evaluate the medical necessity of a proposed medical service. — đáp án hiện tại