Which are the five rights of utilization and review?

• A. Provider, Services, Setting, Time
• B. Provider, Services, Setting, Time, Cost
• C. Provider, Services, Setting, Time, Location
• D. Provider, Services, Setting, Time, Quality

Answer: (B)

The idea behind utilization management is to ensure care is appropriate, necessary, and efficient by checking five key elements. The five rights are the right provider, the right service, the right setting, the right time, and the right cost. Each right helps confirm that the care delivered is by a qualified clinician, for the specific service needed, in a setting appropriate for that service, at a time suitable for the patient’s condition, and at a cost that is appropriate and covered by the plan. The correct option reflects all five components: provider, services, setting, time, and cost. Substituting factors like location or quality for the cost, or omitting cost, doesn’t align with how utilization and review is structured, so those choices aren’t correct.