Payer utilization review (UR) and its effect on ENT practice is best described as:

• A. A clinical decision framework for selecting treatment modalities.
• B. Review to assess medical necessity and coverage for proposed services; ensure documentation supports requests; manage preauthorization and denials.
• C. A marketing program to attract new patients.
• D. A patient satisfaction survey method.

Answer: (B)

Payer utilization review centers on determining whether a proposed ENT service is medically necessary and will be covered by the payer, and it focuses on making sure the documentation supports the request, along with handling preauthorization and possible denials. In practice, this means clinicians must provide clear indications, relevant test results, and guideline-consistent rationale so the payer approves the service before it’s performed, and they may need to appeal or adjust requests if denial occurs. This is not about choosing treatment options clinically, nor about marketing or measuring patient satisfaction. The UR process directly shapes what is approved and what must be documented to obtain coverage.