Utilization Review Licensing in Georgia

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

Georgia Independent Review Organization Certification

Type of Review:

Medical Utilization Review

Agency:Georgia Department of Community Health

Initial Registration

Form:

Application for Certification as an IRO

Agency fee:

$500

Registration Renewal

Form:

Renewal of Certificate of Registration for IRO

Agency fee:

$250

Due:

Annually at least 90 days prior to the anniversary of registration.

Georgia Private Review Agent Certification

Type of Review:

Medical Utilization Review

Agency:Georgia Office of Insurance and Safety Fire Commissioner

Initial Registration

Agency:Georgia Office of Insurance and Safety Fire Commissioner
Form:

Application for Certification as a Private Review Agent

Agency fee:

$1,000

Notarize:Required

Registration Renewal

Agency:Georgia Office of Insurance and Safety Fire Commissioner
Form:

Application for Certification as a Private Review Agent (Renewal)

Agency fee:

$500

Due:

Biennially by the date of issuance.

Notarize:Required

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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