Utilization management (English Wikipedia)

Institute of Medicine (1989), Controlling Costs and Changing Patient Care?: The Role of Utilization Management, Washington, DC, USA: National Academies Press, doi:10.17226/1359, ISBN 978-0-309-04045-7, PMID 25144100.
Moses RE, Feld AD (January 2008). "Legal risks of clinical practice guidelines". The American Journal of Gastroenterology. 103 (1): 7–11. doi:10.1111/j.1572-0241.2007.01399.x. PMID 18184116. S2CID 11802118.
Wulff KC, Miller FG, Pearson SD (December 2011). "Can coverage be rescinded when negative trial results threaten a popular procedure? The ongoing saga of vertebroplasty". Health Affairs. 30 (12): 2269–76. doi:10.1377/hlthaff.2011.0159. PMID 22147854.
Maratt JK, Kerr EA, Klamerus ML, Lohman SE, Froehlich W, Bhatia RS, Saini SD (September 2019). "Measures Used to Assess the Impact of Interventions to Reduce Low-Value Care: a Systematic Review". Journal of General Internal Medicine. 34 (9): 1857–1864. doi:10.1007/s11606-019-05069-5. PMC 6712188. PMID 31250366.
Shapiro MF, Wenger NS (November 1995). "Rethinking utilization review". The New England Journal of Medicine. 333 (20): 1353–4. doi:10.1056/NEJM199511163332012. PMID 7566031.
Steinberg EP, Tunis S, Shapiro D (1995). "Insurance coverage for experimental technologies". Health Affairs. 14 (4): 143–58. doi:10.1377/hlthaff.14.4.143. PMID 8690340.
Porter ME (December 2010). "What is value in health care?". The New England Journal of Medicine. 363 (26): 2477–81. doi:10.1056/NEJMp1011024. PMID 21142528.

dol.gov

"Technical Release No. 2011-02". United States Department of Labor. 2016-07-27. Retrieved 2019-05-19.

dotmed.com

Rozelle TJ, Kantor LS. "Using ERISA to end proton therapy denials". dotmed.com. Retrieved 2019-05-18.

fortherecordmag.com

Eramo LA. "Mitigate Medical Necessity Denials". For the Record. 28 (3): 22. Retrieved 2019-06-24.

hcpro.com

Kares J. "Medically Unlikely Edits and Medical Necessity". Medicare Insider. Retrieved 2019-07-31.

healthcaredive.com

Abraham T. "Anthem ER policy could deny 1 in 6 visits if universally adopted, JAMA study warns". Healthcare Dive. Retrieved 2020-03-12.

huntlawoffice.com

Weinstock J. "The Non-Response (De Facto) Denial". Virginia Hunt Law Office. Retrieved 2019-07-31.

insurancejournal.com

Tozzi J (2018-10-02). "Doctor's Alleged Fraud Scheme Throws Medical Claims Review Process into Doubt". Insurance Journal. Retrieved 2019-05-19.

kff.org

Pollitz K (25 February 2019). "Claims Denials and Appeals in ACA Marketplace Plans". The Henry J. Kaiser Family Foundation. Rachel Fehr Published. Retrieved 2019-05-19.

latimes.com

Karlamangla S (15 December 2015). "Civil rights complaint filed against Medi-Cal". Los Angeles Times. Retrieved 2019-07-31.

lawyersandsettlements.com

Wallace A. "Latest ERISA Lawsuit News – 401k Mismanagement Lawsuits Going Strong, New Settlement in Treatment Denial Case". www.lawyersandsettlements.com. Retrieved 2019-06-15.

modernhealthcare.com

Livingston S (2018-01-25). "Left out of the game: Health systems offer direct-to-employer contracting to eliminate insurers". Modern Healthcare. Retrieved 2019-05-18.
Livingston S (2019-04-29). "Judge recuses himself from UnitedHealthcare proton therapy lawsuits". Modern Healthcare. Retrieved 2019-05-19.

nairo.org

"Understanding Independent Medical Review and Utilization Review Services" (PDF). NAIRO.

nih.gov

pubmed.ncbi.nlm.nih.gov

Institute of Medicine (1989), Controlling Costs and Changing Patient Care?: The Role of Utilization Management, Washington, DC, USA: National Academies Press, doi:10.17226/1359, ISBN 978-0-309-04045-7, PMID 25144100.
Moses RE, Feld AD (January 2008). "Legal risks of clinical practice guidelines". The American Journal of Gastroenterology. 103 (1): 7–11. doi:10.1111/j.1572-0241.2007.01399.x. PMID 18184116. S2CID 11802118.
Wulff KC, Miller FG, Pearson SD (December 2011). "Can coverage be rescinded when negative trial results threaten a popular procedure? The ongoing saga of vertebroplasty". Health Affairs. 30 (12): 2269–76. doi:10.1377/hlthaff.2011.0159. PMID 22147854.
Maratt JK, Kerr EA, Klamerus ML, Lohman SE, Froehlich W, Bhatia RS, Saini SD (September 2019). "Measures Used to Assess the Impact of Interventions to Reduce Low-Value Care: a Systematic Review". Journal of General Internal Medicine. 34 (9): 1857–1864. doi:10.1007/s11606-019-05069-5. PMC 6712188. PMID 31250366.
Olaniyan O, Brown IL, Williams K (2011). "Concurrent utilization review: getting it right". Physician Executive. 37 (3): 50–4. PMID 21675315.
Shapiro MF, Wenger NS (November 1995). "Rethinking utilization review". The New England Journal of Medicine. 333 (20): 1353–4. doi:10.1056/NEJM199511163332012. PMID 7566031.
Steinberg EP, Tunis S, Shapiro D (1995). "Insurance coverage for experimental technologies". Health Affairs. 14 (4): 143–58. doi:10.1377/hlthaff.14.4.143. PMID 8690340.
Porter ME (December 2010). "What is value in health care?". The New England Journal of Medicine. 363 (26): 2477–81. doi:10.1056/NEJMp1011024. PMID 21142528.

ncbi.nlm.nih.gov

Maratt JK, Kerr EA, Klamerus ML, Lohman SE, Froehlich W, Bhatia RS, Saini SD (September 2019). "Measures Used to Assess the Impact of Interventions to Reduce Low-Value Care: a Systematic Review". Journal of General Internal Medicine. 34 (9): 1857–1864. doi:10.1007/s11606-019-05069-5. PMC 6712188. PMID 31250366.

obroncology.com

Lewis T, Buell B (April 2019). "Denial Rates and Days to Pay for Cancer Drugs: Commercial Health Plan Report Card". OBR. 11 (4). Retrieved 2019-06-14.

oklahoman.com

Clay N (2018-11-08). "Oklahoma County jury hits health insurer Aetna with $25.5 million verdict". Oklahoman.com. Retrieved 2019-06-13.

oscn.net

"Ron Cunningham v. Aetna, CJ-2015-2826". Oklahoma State Courts Network.

proquest.com

Olaniyan O, Brown IL, Williams K (2011). "Concurrent utilization review: getting it right". Physician Executive. 37 (3): 50–4. PMID 21675315.

semanticscholar.org

api.semanticscholar.org

Moses RE, Feld AD (January 2008). "Legal risks of clinical practice guidelines". The American Journal of Gastroenterology. 103 (1): 7–11. doi:10.1111/j.1572-0241.2007.01399.x. PMID 18184116. S2CID 11802118.

ssrn.com

papers.ssrn.com

Hoffman S (2000-03-30). "A Proposal for Federal Legislation to Address Health Insurance Coverage for Experimental and Investigational Treatments". Rochester, NY. SSRN 214131. {{cite journal}}: Cite journal requires |journal= (help)

urac.org

Bikoff L (28 January 2016). "ACA specifies 'effective' internal claims appeals process". Utilization Review Accreditation Commission (URAC). Archived from the original on 29 September 2020. Retrieved 2019-05-19.

web.archive.org

Bikoff L (28 January 2016). "ACA specifies 'effective' internal claims appeals process". Utilization Review Accreditation Commission (URAC). Archived from the original on 29 September 2020. Retrieved 2019-05-19.