A method used by a health plan to measure the amount and appropriateness of health services used by its members is called a(n)
A. coinsurance review.
B. capitation review.
C. accountable care review.
D. formulary review.
E. utilization review.
E. utilization review.
A utilization review is the method used by health plans to measure appropriate services. A formulary is a list of approved prescriptions for which it will reimburse subscribers. Capitation is a set advance payment made to providers, and coinsurance refers to the amount of money that insurance plan members pay out of pocket.
Health Professions