Utilization Review Licensing in Nebraska

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

Nebraska Utilization Review Agent Certification

Type of Review:

Medical Utilization Review

Agency:Nebraska Department of Insurance

NE Stat. § 44-5416 et seq.

Fact Checked:7/26/18

Initial Registration

Agency:Nebraska Department of Insurance

Utilization Review Agent Application

Agency Fee:


Fact Checked:7/26/18

Registration Renewal

Agency:Nebraska Department of Insurance
Agency Fee:



Biennially by the date of issuance.


There is no form, instead submit a statement describing any changes in information or documentation submitted with the initial application.

Fact Checked:7/26/18

Nebraska 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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