Utilization Review Licensing in Kentucky
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 |
| Foreign Qualification is Prerequisite: | Not Set |
| Exam Required? | Not Set |
| Registered Agent (Special Agency) Required? | Not Set |
Initial Registration
| Form: | Application for Certification of an Independent Review Entity |
| Agency Fee: | $500 |
Registration Renewal
| 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 |
| Foreign Qualification is Prerequisite: | Not Set |
| Exam Required? | Not Set |
| Registered Agent (Special Agency) Required? | Not Set |
Initial Registration
| Form: | |
| Agency Fee: | $1,000 |
Registration Renewal
Utilization Review Registration Renewal
| Form: | |
| Agency Fee: | $1,000 |
| Due: | Biennially 90 days prior to the date of initial registration. |
Supplemental Reporting
Annual Utilization Review Report
| Form: | HIPMC-UR2 (07/2008) Annual Utilization Review (UR) Report Forms |
| Filing Method: |
|
| Agency Fee: | $0 |
| Due: | Annually by March 31. |
Kentucky Utilization Review/Medical Bill Audit Certification
Initial Registration
| Form: | |
| Agency Fee: | $0 |
| Original Ink: | Not required |
| Notarize: | Not required |
Registration Renewal
| Form: | |
| Agency Fee: | $0 |
| Due: | 4 years from the date of submission. |
| Original Ink: | Not required |
| Notarize: | Not required |
Kentucky 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.
