ABSTRACT
Utilization management (UM) in MBC systems refers to any of several techniques and procedures used to monitor and evaluate the necessity or appropriateness of care for insurance coverage or provider reimbursement purposes. UM ensures that services delivered are appropriate and necessary and are authorized for reimbursement in advance. UM decisions are based on information concerning clients that includes symptoms, diagnostic impressions, tentative treatment plans, response to treatment, and treatment outcomes.
