Utilization Review Licensing in Connecticut

A nurse holding up a broken patients arm.

Utilization review licenses and certificates are typically issued for organizations conducting either medical or workers’ compensation reviews. This guide contains information about utilization review in Connecticut. For assistance with licensing, please contact us to learn about our software and managed license services.

Connecticut Utilization Review License

Type of Review:

Medical Utilization Review

Agency:Connecticut Insurance Department
Law:

CT Stat § 38a-591-1

Initial Registration

Form:

Utilization Review - Company License Application

Agency Fee:

A $3,000 fee is due after the department reviews the application, an invoice will be sent.

Required Attachments:
  • Sample copies of approval notices to covered persons and, if applicable, the covered person's authorized representative/provider of record.
  • Sample copies of the initial adverse determination notices sent to covered persons and, if applicable, authorized representative/provider of record.
  • Sample copies of adverse determination of appeal notices (final) sent to covered persons and, if applicable, authorized representative/provider of record.

Registration Renewal

Form:

Utilization Review - Company License Application (Renewal)

Agency Fee:

$3,000

Due:

Annually by October 1.

Connecticut Resources

Adverse Determination - When a health care plan or utilization review program decides that a medical treatment or service is not necessary.

Concurrent Review - Utilization review that is conducted during a patient’s course of treatment.

External Review - When an independent review organization is consulted to appeal an insurance company’s adverse determination.

Independent Review Organization (IRO) - Unbiased third-parties that conduct utilization review.

Prospective Review - Utilization review that occurs prior to treatment.

Retrospective Review - Utilization review that occurs after treatment and often after payment.

Utilization Review - A system for evaluating the medical necessity, efficiency, and appropriateness of medical services.

Utilization Review Agent (URA) - An entity that conducts utilization review.

Utilization Review Plan - A document of the procedures used during utilization review.