Utilization Review Licensing in Iowa
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 |
| Foreign Qualification is Prerequisite: | Not Set |
| Exam Required? | Not Set |
| Registered Agent (Special Agency) Required? | Not Set |
Initial Registration
| Form: | |
| Agency Fee: | $0 |
| Required Attachments: |
|
Registration Renewal
| Form: | |
| Agency Fee: | $0 |
| Due: | Biennially |
Iowa Utilization Reviewer Statement of Certification
Automatic Exemption
| Exemption Eligible Organizations: | Entities that perform utilization review solely under contract with
|
| Law: | IAC § 70.3(3) |
Initial Registration
| Filing Method: | |
| Agency Fee: | $0 |
| Required Attachments: |
|
Registration Renewal
| Filing Method: | |
| Agency Fee: | $0 |
| Due: | Annually by March 1. |
Iowa 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.
