Utilization Review Licensing in Missouri

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

Missouri Utilization Review Agent Registration

Type of Review:

Medical Utilization Review

Agency:Missouri Department of Insurance

MO Stat. § 374.503

Fact Checked:2/18/21

Initial Registration


Certificate of Registration Application for Utilization Review

Agency Fee:


Required Attachments:
  • List of all other locations
  • List of officers, directors, and partners
  • Name, address, and medical license number for the entity's Missouri-licensed medical director
  • List of clients including addresses, phone numbers, contact names and emails
Fact Checked:2/18/21

Registration Renewal


Certificate of Registration Application for Utilization Review (Renewal)

Agency Fee:



Annually by the anniversary date of issuance.

Fact Checked:2/18/21

Missouri 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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