In certain situations, a health plan can use the results of utilization review to intervene, if necessary, to alter the course of a plan member's medical care. Such intervention can be based on the results of

Question

Quizplus · Accepted Answer

Utilization review can involve both prospective and concurrent review, as well as review of pending cases. Therefore, the best choice is D, which includes all three options.

In Certain Situations, a Health Plan Can Use the Results