Utilization Review Licensing in South Dakota

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

South Dakota Independent Review Organization License

Type of Review:

Medical Utilization Review

Agency:South Dakota Department of Labor and Regulation - Division of Insurance

Initial Registration

Agency:South Dakota Department of Labor and Regulation - Division of Insurance
Form:

Independent Review Organization Application

Agency fee:

$250

Registration Renewal

Agency:South Dakota Department of Labor and Regulation - Division of Insurance
Form:

Independent Review Organization Application (Renewal)

Agency fee:

$250

Due:

Annually by September 30.

South Dakota Managed Care Plan Certification

Type of Review:

Workers' Compensation Utilization Review

Agency:South Dakota Department of Labor and Regulation - Division of Labor and Management

Initial Registration

Agency:South Dakota Department of Labor and Regulation - Division of Labor and Management
Form:

Case Management Plan Certification Application

Agency fee:

$250

Registration Renewal

Agency:South Dakota Department of Labor and Regulation - Division of Labor and Management
Agency fee:

$250

Due:

Annually by July 1.

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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