Utilization Review Licensing in Oklahoma
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 Oklahoma. For assistance with licensing, please contact us to learn about our software and managed license services.
Oklahoma Medical Case Manager License
| Type of Review: | Workers' Compensation Utilization Review |
| Agency: | Oklahoma Workers Compensation Commission |
| Fact Checked: | 7/26/18 |
Initial Registration
| Agency: | Oklahoma Workers Compensation Commission |
| Form: | |
| Agency Fee: | $0 |
| Fact Checked: | 7/26/18 |
Oklahoma Utilization Review Registration
| Type of Review: | Medical Utilization Review |
| Agency: | Oklahoma Insurance Department |
| Fact Checked: | 7/26/18 |
Initial Registration
| Agency: | Oklahoma Insurance Department |
| Form: | Utilization Review Certification and/or Registration Application |
| Filing Method: | Applicants must use the online SERFF system to apply. |
| Agency Fee: | $500 |
| Notarize: | Required |
| Fact Checked: | 7/26/18 |
Registration Renewal
| Agency: | Oklahoma Insurance Department |
| Form: | Utilization Review Certification and/or Registration Annual Renewal Application |
| Agency Fee: | $500 |
| Due: | Annually |
| Notarize: | Required |
| Fact Checked: | 7/26/18 |
Oklahoma 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.
