1. Evaluation of services by contractor medical personnel; includes analysis of claims data to identify potential billing problems resulting in inappropriate utilization situations; includes various plans of action to correct the problem. 2. In the Medicaid program, an analysis by a team composed of physicians and other appropriate health and social service personnel may be required to assess the patient’s condition and need for care (e.g., medical evaluations of inpatients in a long-term care facility). Also called continued stay review . 3. In the Medicare program, an evaluation by a Medicare administrative contractor and/or quality improvement organization (QIO) of services rendered by health care providers. This assessment is done to determine if the services are reasonable and necessary; services meet Medicare guidelines; quality of service is in line with the standards of health care; services are medically appropriate in an inpatient, outpatient, or other setting; and services are supported by documentation. Also called utilization review .