State RegulationsCO specificDifficulty 2/5
In Colorado health coverage, utilization review under C.R.S. § 10-16-113 refers to:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under C.R.S. § 10-16-113, utilization review is a program under which a carrier evaluates the medical necessity and appropriateness of proposed or delivered health care services. Colorado's utilization review statutes and Division of Insurance regulations such as Reg. 4-2-17 govern how these programs must operate.
Why the other options are wrong
- A) Utilization review evaluates the medical necessity and appropriateness of care, not merely billing errors.
- B) It is the carrier's review of health care services, not the insured's review of policy benefits.
- D) Policy form review is a Division of Insurance function, distinct from a carrier's utilization review program.
Memory hook
UR asks: is this care medically necessary?