Utilization Review Licensing in Louisiana

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

Louisiana Independent Review Organization Registration

Type of Review:

Medical Utilization Review

Agency:Louisiana Department of Insurance

Initial Registration

Agency:Louisiana Department of Insurance
Form:

Independent Review Application

Agency fee:

$500

Registration Renewal

Not required



IRO registrations do not expire.

More information: Louisiana Department of Insurance

Louisiana Utilization Review Organization Registration

Type of Review:

Medical Utilization Review

Agency:Louisiana Department of Insurance
Law:

LA Stat. § 22:2395

Initial Registration

Agency:Louisiana Department of Insurance
Form:

Utilization Review Organization (URO) Application

Agency fee:

$1,500

Notarize:Required

Registration Renewal

Not required



URO registrations do not expire.

More information: Louisiana Department of Insurance

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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