Utilization Review Licensing in Tennessee

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

Tennessee External Review Registration

Type of Review:

Medical Utilization Review

Agency:Tennessee Department of Commerce & Insurance
Law:

TN Code § 56-61-120

Registered Agent (Special Agency) Required?Yes

Initial Registration

Form:

External Review Organizations Application Packet

Agency Fee:

$500 for accredited entities and $1,500 for unaccredited entities.

Required Attachments:

See the application form for a detailed list of attachments.

Registration Renewal

Form:

External Review Organizations Application Packet (Renewal)

Agency Fee:

$500 for accredited entities and $1,500 for unaccredited entities.

Due:

Biennially by the registration anniversary date.

Tennessee Utilization Review Organization Registration

Type of Review:

Workers' Compensation

Agency:Tennessee Department of Labor & Workforce Development - Bureau of Workers' Compensation
Law:

TN Admin Code 0800-02-06-.02

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

Initial Registration

Form:

Form C-39: Provider Registration for Utilization Review

Agency Fee:

$0

Required Attachments:
  • A copy of the “Approved” certification letter, issued by the Tennessee Department of Commerce and Insurance
  • Proof of all certifications listed on the application

Renewal Not Required

Not required



Tennessee Utilization Review Registration

Type of Review:

Medical Utilization Review

Agency:Tennessee Department of Commerce & Insurance
Law:

TN Code § 56-6-704 

Initial Registration

Form:

Utilization Review Application Packet

Filing Method:

Mail or email to Ins.Policy.Analysis@tn.gov

Agency Fee:

$1,000 for unaccredited entities. Accredited entities have no fee.

Required Attachments:
  • An attachment with appeals procedures, as required by Tenn. Code Ann. § 56-6-704
  • Proof of a valid Utilization Review Accreditation Commission (URAC) or National Committee for Quality Assurance (NCQA) accreditation

Registration Renewal

Form:

Utilization Review Application Packet (Renewal)

Filing Method:

Mail or email to Ins.Policy.Analysis@tn.gov

Agency Fee:

$1,000 for unaccredited entities. Accredited entities have no fee.

Due:

Annually by July 1.

Required Attachments:
  • An attachment with appeals procedures, as required by Tenn. Code Ann. § 56-6-704
  • Proof of a valid Utilization Review Accreditation Commission (URAC) or National Committee for Quality Assurance (NCQA) accreditation

Tennessee Resources

Annual Report Apostille - Authentication Architecture Firm License Articles of Incorporation Articles of Limited Partnership Articles of Organization Business License Certificate of Authority Certificate of Cancellation Service Certificate of Good Standing / Existence Certificate of Merger Certification - Authentication Change Your Registered Agent
Charitable Gaming License Charitable Gift Annuity Licensing Compliance Charitable Registration Construction License Converting Your Entity Corporation LLC Nonprofit Amendment Dissolve Corporation LLC Nonprofit Employer (Payroll & Withholding Tax) Registration Service Employment Agency Licensing Energy Licensing Engineering Firm License Entity Name Reservation Fictitious Name Registration & Renewal
Finance Licensing In Foreign Corporation Foreign LLC Healthcare and Pharmaceutical Licenses How to Form an LLC How to Incorporate How to Start a Nonprofit Organization Insurance Licensing Licensing Resources Moving Your Company's Domicile to Nonprofit Articles of Incorporation Nonprofit Compliance Obtain Certified Copies
Private Investigator License Real Estate Licensing Registered Agent Service Reinstate Corporation LLC Nonprofit Sales & Use Tax Registration Service Sales Tax Exemption Start a Business Tax Clearance Certificate Tax Exemption Utilization Review Certification / License

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.

Revised October 27, 2025. Complete data last reviewed February 18, 2021.