Utilization Review Licensing in Mississippi

A nurse holding up a broken patients arm.

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

Mississippi Private Review Agency Certification

Type of Review:

Medical Utilization Review

Agency:Mississippi State Department of Health

MS Code § 41-83-3

Foreign Qualification is Prerequisite:Not Set

No certificate is required for those private review agents conducting general in-house utilization review for hospitals, home health agencies, preferred provider organizations or other managed care entities, clinics, private physician offices or any other health facility or entity, so long as the review does not result in the approval or denial of payment for hospital or medical services for a particular case.

Exam Required?Not Set
Registered Agent (Special Agency) Required?Not Set

Initial Registration

Agency Fee:



Contact the department for an application form.

Required Attachments:
  • Utilization review plan
  • A written protocol describing the appeals procedure
  • A copy of any form which shall be completed during the appeals procedure
  • Time frames that shall be met during the appeal procedure
  • The names and qualifications of personnel making final appeal determinations

Registration Renewal

Agency Fee:



Biennially by the date of issuance.


Contact the department for a renewal form.

Mississippi 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.