Utilization Review Licensing in Alabama

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

Alabama Qualified Utilization Review Entity Certificate

Type of Review:

Workers' Compensation Utilization Review

Agency:Alabama Department of Labor
Law:

AAC 480-5-5-.06

Initial Registration

Form:

Application for Certification

Agency Fee:

$0

Registration Renewal

Form:

Application for Certification (Renewal)

Agency Fee:

$0

Due:

Biennially by the date of issuance.

Alabama Utilization Review Agent Certification

Type of Review:

Medical Utilization Review

Agency:Alabama Department of Public Health
Law:

AL Code § 27-3A-1 et seq.

Initial Registration

Form:

Application for Certification as a UR Review Agent, Attachment A, and Policy and Procedure Checklist (if not accredited through URAC).

Agency Fee:

$0 for URAC accredited entities and $1,000 for non-accredited entities.

Notarize:Required
Required Attachments:

URAC Certified Entities:

  • Attach copy of current certificate of accreditation specific to Health Utilization Management Standards with the application
  • Complete Attachment A (Additional UR sites). Complete this item even if there are no additional sites

 

Non-Accredited Entities:

  • A copy of your policies and procedure which support compliance with the §Code of Alabama 27-3A-5
  • A copy of the complaint and appeals procedures for utilization review determinations
  • Attachment A ("Additional UR Sites"). Complete this item even if there are no additional sites. Select "none" if there are no additional sites and submit attachment with application

Registration Renewal

Form:

Renewal Application for URAC Accredited Agents or Renewal Application for Non-URAC Accredited Agents

Agency Fee:

$0 for URAC accredited entities and $1,000 for non-accredited entities.

Due:

Annually by June 30.

Notarize:Required
Notes:

Separate renewal forms should be filed for each additional physical site other than the location given.

Before you Apply:

URAC Certified Entities:

  • Copy of current URAC accreditation certification or a letter from URAC if accreditation is in process of renewal
  • Attachment A (Additional UR Sites)

 

Non-Accredited Entities:

  • Policy & Procedure Checklist Form
  • A copy of the complaint and appeal process
  • Policy Attestation Statement
  • Attachment A with contact person information for each UR Site

Alabama Resources

Annual Report & Business Privilege Tax Apostille - Authentication Architecture Firm License Articles of Incorporation 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 DBA 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
Foreign Corporation Foreign LLC General Partnership Healthcare and Pharmaceutical Licenses How to File Articles of Incorporation (Certificate of Formation) 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 & Commercial Clerk Reinstate Corporation LLC Nonprofit Sales & Use Tax Registration Service Sales Tax Exemption Sole Proprietorship 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 February 18, 2021. Complete data last reviewed February 18, 2021.
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