Utilization Review Licensing in Arizona

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

Arizona Utilization Review Agent Registration

Type of Review:

Medical Utilization Review

Agency:Arizona Department of Insurance

AZ Stat. § 20-2501 et seq.

Foreign Qualification is Prerequisite:Yes

Registration is required for agents that perform utilization review for fully insured commercial business. Agents that only conduct reviews for government coverage (Medicare or Medicaid) are not required to register. Additionally, URAC accredited agents and other agents described in AZ Stat. § 20-2502 are exempt from registration requirements.

Fact Checked:2/12/21

Initial Registration

Agency Fee:



Contact the Life and Health Division at 602-364-2393 for application forms.

Required Attachments:
  • A certificate of good standing from the Arizona Corporation Commission.
  • A copy of a national UR accreditation certificate (URAC, NCQA or AAGC) if applicable.
  • A utilization review plan that includes a summary description of review guidelines, protocols and procedures, standards and criteria to be used in evaluating inpatient hospital care, inpatient medical care, outpatient surgical care and any medical, surgical and health care services that may be covered by a health care insurer and the provisions by which patients, providers or hospitals may seek reconsideration or appeal of decisions made by the utilization review agent.
  • A list of all contracts (if any) the entity has with a health care insurer or third party administrator to conduct utilization review for fully insured commercial plans in Arizona.
  • A copy of the materials or a description of the procedure designed to inform patients and providers, as appropriate, of the requirements of the utilization review plan.
Fact Checked:2/4/21

Registration Renewal

Agency Fee:



Triennially by the anniversary of certification.

Fact Checked:2/4/21

Arizona 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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