Utilization Review Licensing in Kentucky

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

Kentucky Independent Review Entity Certification

Type of Review:

Medical Utilization Review

Agency:Kentucky Department of Insurance

Initial Registration

Agency:Kentucky Department of Insurance
Form:

Application for Certification of an Independent Review Entity

Agency fee:

$500

Registration Renewal

Agency:Kentucky Department of Insurance
Form:

Application for Certification of an Independent Review Entity (Renewal)

Agency fee:

$500

Due:

Biennially

Kentucky Utilization Review Registration

Type of Review:

Medical Utilization Review

Agency:Kentucky Department of Insurance

Initial Registration

Agency:Kentucky Department of Insurance
Form:

Utilization Review Registration Application

Agency fee:

$1,000

Registration Renewal

Agency:Kentucky Department of Insurance
Form:

Utilization Review Registration Application (Renewal)

Agency fee:

$1,000

Due:

Biennially by the registration anniversary date.

Supplemental Reporting
Annual Utilization Review Report

Form:

HIPMC-UR2 (07/2008) Annual Utilization Review (UR) Report Forms

Filing method:
  • Mail
  • Fax: 502-564-2728
  • Email: DOI.HealthMail@ky.gov
Agency fee:

$0

Due:

Annually by March 31.

Kentucky Utilization Review/Medical Bill Audit Certification

Type of Review:

Workers' Compensation Utilization Review

Agency:Kentucky Labor Cabinet - Department of Workers' Claims

Initial Registration

Agency:Kentucky Labor Cabinet - Department of Workers' Claims
Form:

Utilization Review/Medical Bill Audit Application

Agency fee:

$0

Original Ink:Not required
Notarize:Not required

Registration Renewal

Agency:Kentucky Labor Cabinet - Department of Workers' Claims
Form:

Utilization Review/Medical Bill Audit Application (Renewal)

Agency fee:

$0

Due:

4 years from the date of submission.

Original Ink:Not required
Notarize:Not required

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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