Utilization Review Licensing in Iowa

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

Iowa Independent Review Organization Certification

Type of Review:

Medical Utilization Review

Agency:Iowa Insurance Division

Initial Registration

Agency:Iowa Insurance Division
Form:

Independent Review Organization Application

Agency fee:

$0

Registration Renewal

Agency:Iowa Insurance Division
Form:

Independent Review Organization Application (Renewal)

Agency fee:

$0

Due:

Biennially

Iowa Utilization Reviewer Statement of Certification

Type of Review:

Medical Utilization Review

Agency:Iowa Insurance Division

Initial Registration

Agency:Iowa Insurance Division
Agency fee:

$0

Notes:

There is no application, but entities that conduct utilization review are required to certify that they are in compliance with the relevant laws and must also submit entity information.

Registration Renewal

Agency:Iowa Insurance Division
Agency fee:

$0

Due:

Annually by March 1.

Notes:

There is no renewal application, simply submit a certification statement and all required entity information.

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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