Utilization Review Licensing in Illinois

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

Illinois Utilization Review Organization Registration

Type of Review:

Medical or Workers' Compensation Utilization Review

Agency:Illinois Department of Insurance

Initial Registration

Agency:Illinois Department of Insurance
Form:

Application for Registration of a Utilization Review Organization

Agency fee:

$1,500 for accredited organizations or $3,000 for unaccredited organizations.

Registration Renewal

Agency:Illinois Department of Insurance
Form:

Health Care/Workers' Compensation Utilization Review Renewal Registration Form

Agency fee:

$1,500 for accredited organizations or $3,000 for unaccredited organizations.

Due:

Biennially

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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