Utilization Review Licensing in Kansas
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 Kansas. For assistance with licensing, please contact us to learn about our software and managed license services.
Kansas Utilization Review Organization Certificate
|Type of Review:|
Medical Utilization Review
|Agency:||Kansas Insurance Department|
KS Stat. § 40-22a04
|Foreign Qualification is Prerequisite:||Not Set|
|Exam Required?||Not Set|
|Registered Agent (Special Agency) Required?||Not Set|
$0 for URAC accredited entities and $100 for non-accredited entites.
$0 for URAC accredited entities and $50 for non-accredited entites.
If your organization is URAC accredited, renewal is every 3 years, consistent with URAC requirements. If your organization has a standard Kansas URO certificate, then the renewal is due annually.
See the instructions for renewal listed on this page.
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.