Utilization Review Licensing in Alabama

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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 Alabama. For assistance with licensing, please contact us to learn about our software and managed license services.

Alabama Utilization Management Certification

Type of Review:

Workers' Compensation Utilization Review

Agency:Alabama Department of Labor

Initial Registration

Agency:Alabama Department of Labor
Form:

Application for Certification

Agency fee:

$0

Registration Renewal

Agency:Alabama Department of Labor
Form:

Application for Certification (Renewal)

Agency fee:

$0

Due:

Biennially

Alabama Utilization Review Agent Certification

Type of Review:

Medical Utilization Review

Agency:Alabama Department of Public Health
Law:

AL Code § 27-3A-1 et seq.

Initial Registration

Agency:Alabama Department of Public Health
Form:

Application for Certification as a UR Review Agent

Agency fee:

$0 for URAC accredited entities and $1,000 for non-accredited entities.

Notarize:Required
Notes:

Satellite site information and a policy and procedure checklist must also be submitted with the application.

Registration Renewal

Agency:Alabama Department of Public Health
Form:

Renewal Application for URAC Accredited Agents or Renewal Application for Non-URAC Accredited Agents

Agency fee:

$0 for URAC accredited entities and $1,000 for non-accredited entities.

Due:

Annually by June 30.

Notarize:Required
Notes:

Separate renewal forms should be filed for each additional physical site other than the location given.

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.

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