Tools commonly used in the Health Care Utilization Review industry for day-to-day tasks and operations.

• Medical coding software
• Electronic health record systems
• Clinical decision support tools
• Utilization management software
• Case management software
• Medical necessity criteria
• Quality improvement tools
• Data analytics software
• Risk assessment tools
• Patient satisfaction surveys

Common products and services typical of NAICS Code 621999-16, illustrating the main business activities and contributions to the market.

• Medical claims review
• Prior authorization services
• Case management
• Disease management
• Utilization management
• Quality improvement
• Medical necessity review
• Peer review
• Independent medical examination
• Disability management

The specific certifications, permits, licenses, and regulatory compliance requirements within the United States for this industry.

• Certified Professional In Healthcare Quality (CPHQ): This certification is offered by the National Association for Healthcare Quality (NAHQ) and is designed for professionals who are involved in healthcare quality management. The certification demonstrates a comprehensive understanding of healthcare quality management principles and practices.
• Utilization Management Certification: This certification is offered by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) and is designed for professionals who are involved in utilization management. The certification demonstrates a comprehensive understanding of utilization management principles and practices.
• Certified Professional In Healthcare Information and Management Systems (CPHIMS): This certification is offered by the Healthcare Information and Management Systems Society (HIMSS) and is designed for professionals who are involved in healthcare information and management systems. The certification demonstrates a comprehensive understanding of healthcare information and management systems principles and practices.
• Certified In Healthcare Privacy and Security (CHPS): This certification is offered by the American Health Information Management Association (AHIMA) and is designed for professionals who are involved in healthcare privacy and security. The certification demonstrates a comprehensive understanding of healthcare privacy and security principles and practices.
• Certified Professional In Healthcare Risk Management (CPHRM): This certification is offered by the American Hospital Association (AHA) and is designed for professionals who are involved in healthcare risk management. The certification demonstrates a comprehensive understanding of healthcare risk management principles and practices.

A concise historical narrative of NAICS Code 621999-16 covering global milestones and recent developments within the United States.

• The Health Care Utilization Review industry has a long history dating back to the early 1900s when the first hospital utilization review committee was established in the United States. The industry has since evolved to become an integral part of the healthcare system, with the introduction of new technologies and regulations. In the 1970s, the federal government passed the Health Maintenance Organization Act, which led to the creation of health maintenance organizations (HMOs) and the increased use of utilization review. In the 1980s, the industry saw the introduction of computerized utilization review systems, which allowed for more efficient and accurate reviews. In recent years, the industry has continued to evolve with the increased use of data analytics and artificial intelligence to improve the utilization review process. In the United States, the Health Care Utilization Review industry has undergone significant changes in recent years. The passage of the Affordable Care Act in 2010 led to an increased focus on cost containment and quality improvement, which has driven the growth of the industry. The industry has also seen increased consolidation, with larger companies acquiring smaller ones to gain a competitive advantage. In addition, the industry has seen the increased use of telemedicine and other digital technologies to improve the utilization review process. Overall, the Health Care Utilization Review industry has a rich history and continues to play a critical role in the healthcare system.

The anticipated future trajectory of the NAICS 621999-16 industry in the USA, offering insights into potential trends, innovations, and challenges expected to shape its landscape.

• Growth Prediction: Stable

  The Health Care Utilization Review industry is expected to grow in the coming years due to the increasing demand for healthcare services and the need to control healthcare costs. The industry is expected to benefit from the aging population, which will require more healthcare services, and the implementation of the Affordable Care Act, which will increase the number of people with health insurance. Additionally, the industry is expected to benefit from the increasing use of technology, such as electronic health records and telemedicine, which will improve the efficiency of healthcare services. However, the industry may face challenges due to the changing healthcare landscape and the need to adapt to new regulations and policies.

Recent groundbreaking advancements and milestones in the Health Care Utilization Review industry, reflecting notable innovations that have reshaped its landscape.

• Artificial Intelligence-Powered Utilization Review Software: This software uses machine learning algorithms to analyze medical records and identify cases that require further review, improving the accuracy and efficiency of utilization review.
• Telemedicine Utilization Review: Utilization review can now be conducted remotely through telemedicine, allowing for faster and more convenient review of medical cases.
• Real-Time Utilization Review: Utilization review can now be conducted in real-time, allowing for faster decision-making and reducing the need for retrospective review.
• Integration with Electronic Health Records: Utilization review can now be integrated with electronic health records, allowing for more efficient and accurate review of medical cases.
• Patient-Centered Utilization Review: Utilization review is now being conducted with a focus on patient outcomes and satisfaction, rather than just cost containment, leading to better quality of care.