Commission for Case Manager Certification (CCMC) Exam 2026 – 400 Free Practice Questions to Pass the Exam

The five rights of utilization review are foundational principles designed to ensure that healthcare services are provided effectively and efficiently. The correct answer encompasses essential components that guide utilization review processes in the healthcare setting.

The rights of utilization review include:

- **Provider**: Ensuring that the services are delivered by an appropriate and qualified healthcare provider. This right emphasizes the importance of matching the provider's skills and credentials with the needs of the patient.

- **Services**: This relates to the specific healthcare services being utilized and whether they are appropriate for the patient's condition. Ensuring that the services align with medical necessity is critical for both patient care and cost management.

- **Setting**: The healthcare setting where services are provided plays a significant role in the quality and appropriateness of care. This right stresses the need for services to occur in the most suitable and effective environment, whether that be inpatient, outpatient, or another facility.

- **Time**: Timing is crucial for patient outcomes. Services must be delivered at the right moment to ensure that they are effective. Delays can negatively impact recovery and lead to complications.

- **Cost**: Cost considerations are vital in healthcare to ensure that necessary services are provided without unnecessary expenditure. This right aims to balance quality care with financial implications