Utilization Review Licensing in Kansas

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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 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

Initial Registration

Agency:Kansas Insurance Department
Form:

Application for Utilization Review Certificate

Agency fee:

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

Notarize:Required

Registration Renewal

Agency:Kansas Insurance Department
Agency fee:

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

Due:

Annually

Notes:

URAC accredited entities must submit a copy of their renewed URAC certificates. Non-accredited entities must the continuation fee.

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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