Utilization Review Licensing in Maryland

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

Maryland Private Review Organization Certification

Type of Review:

Medical or Workers' Compensation Utilization Review

Agency:Maryland Insurance Administration

Initial Registration

Form:

Private Review Agent Certification Application

Agency Fee:

$1,500

Required Attachments:

Registration Renewal

Agency Fee:

$1,500

Due:

Biennially by the date of issuance.

Maryland Resources

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Nonprofit Compliance Obtain Certified Copies Private Investigator License Real Estate Licensing Registered Agent (Resident 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 February 05, 2021. Complete data last reviewed February 05, 2021.
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