In Utilization Review, what is one of the roles regarding insurance carriers?

In Utilization Review, obtaining necessary approvals for services is a critical function. This role involves evaluating the medical necessity and appropriateness of care prior to the delivery of services. By assessing whether proposed treatments meet established criteria and guidelines, Utilization Review ensures that the patient receives appropriate care while also managing the costs incurred by insurance carriers. This process helps mitigate unnecessary expenditures and aligns care delivery with best practices, ultimately facilitating the payer's responsibilities in covering necessary treatments.

The other options relate to functions that, while integral to the insurance process, do not fall under the specific scope of Utilization Review. Setting insurance premiums involves assessing risk factors across a broader population rather than individual service authorization. Processing insurance claims typically occurs after services have been rendered and is focused on the reimbursement aspect rather than pre-service approval. Conducting insurance audits usually pertains to reviewing compliance and financial practices rather than the evaluation of specific services for necessity.