Utilization Review Licensing in Kansas

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

Kansas Utilization Review Organization Certificate

Type of Review:

Medical Utilization Review

Agency:Kansas Insurance Department
Law:

KS Stat. § 40-22a04

Fact Checked:2/5/21

Initial Registration

Form:

Application for Utilization Review Certificate

Agency Fee:

$0 for URAC accredited entities and $100 for non-accredited entites.

Notarize:Required
Required Attachments:
  • URAC certificate of accreditation (if applicable)
  • A certified copy of the URO’s charter or articles of incorporation and bylaws
Fact Checked:2/5/21

Registration Renewal

Agency Fee:

$0 for URAC accredited entities and $50 for non-accredited entites.

Due:

If your organization is URAC accredited, renewal is every 3 years, consistent with URAC requirements.  If your organization has a standard Kansas URO certificate, then the renewal is due annually.

Notes:

See the instructions for renewal listed on this page.

Required Attachments:
  • Current URAC accreditation certificate (if applicable)
  • Any/all changes within the prior year to your organization’s Policy and Procedure documents and/or support material
  • Notification of any change in officers (please submit an updated organizational chart)
  • Notification of contact person and phone information
  • Notification of change in address, phone number, and e-mail address
  • Notification of any additions or deletions to review site locations
  • Any other material changes to your organization of policy and procedures documents
Fact Checked:2/5/21

Kansas 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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