Retrospective Review

Retrospective review is the type of UM that occurs after the care was delivered and after the bill for that care was submitted. The retrospective review seeks to confirm that the care was appropriate and was provided at the most efficient and effective level. Additionally, the retro review also determines if the codes used to describe the care listed on the submitted bill are coded correctly according to such standards as Current Procedural Terminology (CPT) and the International Classification of Diseases-10 (ICD-10). Ideally, the retrospective review should uncover only minimal discrepancies with information that might be available from the pre-auth and concurrent review processes when available. The retrospective review also provides an opportunity to collect data related to the quality of care, compliance with national standards, and additional outcomes data that can be shared with providers and throughout the organization. Source: Giardino AP, Wadhwa R. Utilization Management. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: [https://www.ncbi.nlm.nih.gov/books/NBK560806/](https://www.ncbi.nlm.nih.gov/books/NBK560806/)