Specialist Service
Utilisation Review
Utilisation review services for radiology and pathology claims, helping medical schemes assess appropriateness and manage healthcare expenditure.
Verirad assists medical schemes with utilisation review for radiology and pathology claims. The service considers whether claimed services appear appropriate, necessary and consistent with expected utilisation patterns.
Utilisation review can help identify over-servicing, unusual provider behaviour, repeated testing, duplication and other cost drivers.
By applying independent review, schemes can improve claims governance and support sustainable benefit management.
Frequently asked questions
What is utilisation review?
Utilisation review assesses whether healthcare services claimed are appropriate, necessary and consistent with expected use.
Why does utilisation review matter?
It helps medical schemes identify unnecessary or excessive claiming patterns.
Does this apply to radiology and pathology?
Yes. Verirad focuses on radiology and pathology claims for medical schemes.
Contact Verirad to discuss this service.