Utilization Review Licensing in Alabama

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 Qualified Utilization Review Entity Certificate

Type of Review:

Workers' Compensation Utilization Review

Agency:Alabama Department of Labor
Law:

AAC 480-5-5-.06

Fact Checked:2/18/21

Initial Registration

Form:

Application for Certification

Agency Fee:

$0

Fact Checked:2/18/21

Registration Renewal

Form:

Application for Certification (Renewal)

Agency Fee:

$0

Due:

Biennially by the date of issuance.

Fact Checked:2/18/21

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.

Fact Checked:2/18/21

Initial Registration

Form:

Application for Certification as a UR Review Agent, Attachment A, and Policy and Procedure Checklist (if not accredited through URAC).

Agency Fee:

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

Notarize:Required
Required Attachments:

URAC Certified Entities:

  • Attach copy of current certificate of accreditation specific to Health Utilization Management Standards with the application
  • Complete Attachment A (Additional UR sites). Complete this item even if there are no additional sites

 

Non-Accredited Entities:

  • A copy of your policies and procedure which support compliance with the §Code of Alabama 27-3A-5
  • A copy of the complaint and appeals procedures for utilization review determinations
  • Attachment A ("Additional UR Sites"). Complete this item even if there are no additional sites. Select "none" if there are no additional sites and submit attachment with application
Fact Checked:2/18/21

Registration Renewal

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.

Before you Apply:

URAC Certified Entities:

  • Copy of current URAC accreditation certification or a letter from URAC if accreditation is in process of renewal
  • Attachment A (Additional UR Sites)

 

Non-Accredited Entities:

  • Policy & Procedure Checklist Form
  • A copy of the complaint and appeal process
  • Policy Attestation Statement
  • Attachment A with contact person information for each UR Site
Fact Checked:2/18/21

Alabama 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.

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