Utilization Review Licensing in South Dakota

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 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

Long Term Care Utilization Review

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

SD Admin Rules 20:06:53:55

Initial Registration

Filing Method:

Online through Sircon.

Agency Fee:

$250

Registration Renewal

Filing Method:

Online through Sircon.

Agency Fee:

$250

Due:

Biennially

South Dakota Utilization Review Organization (URO) Registration

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

South Dakota Codified Law § 58-17H-35

Foreign Qualification is Prerequisite:No
Registered Agent (Special Agency) Required?No

Initial Registration

Filing Method:

Online through Sircon.

Agency Fee:

$250

Registration Renewal

Filing Method:

Online through Sircon.

Agency Fee:

$250

Due:

Annually by July 1.

South Dakota 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.