Utilization Review Licensing in South Carolina

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

South Carolina Utilization Review Agent Registration

Type of Review:

Medical Utilization Review

Agency:South Carolina Department of Insurance
Fact Checked:7/26/18

Initial Registration

Agency:South Carolina Department of Insurance

Form 2510: Application for Private Review Agent

Agency Fee:


Fact Checked:7/26/18

Registration Renewal

Agency:South Carolina Department of Insurance

Form 1031RN: Application for Renewal Utilization Review

Agency Fee:



Biennially by the date of issuance.

Fact Checked:7/26/18

South Carolina 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.

© 2012 - 2020 Harbor Compliance. All rights reserved. Harbor Compliance does not provide tax, financial, or legal advice. Use of our services does not create an attorney-client relationship. Harbor Compliance is not acting as your attorney and does not review information you provide to us for legal accuracy or sufficiency. Access to our website is subject to our Terms of Use and Service Agreement.