Utilization Review Licensing in Missouri

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

Missouri Utilization Review Agent Registration

Type of Review:

Medical Utilization Review

Agency:Missouri Department of Insurance
Law:

MO Stat. § 374.503

Initial Registration

Form:

Certificate of Registration Application for Utilization Review

Agency Fee:

$1,000

Notarize:Required
Required Attachments:
  • List of all other locations
  • List of officers, directors, and partners
  • Name, address, and medical license number for the entity's Missouri-licensed medical director
  • List of clients including addresses, phone numbers, contact names and emails

Registration Renewal

Form:

Certificate of Registration Application for Utilization Review (Renewal)

Agency Fee:

$500

Due:

Annually by the anniversary date of issuance.

Notarize:Required

Missouri Resources

Annual Report 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 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 Healthcare and Pharmaceutical Licenses How to Form an LLC How to Incorporate How to Start a Nonprofit Organization Insurance Licensing Licensing Resources Missour Registered Agent Service Moving Your Company's Domicile to Nonprofit Articles of Incorporation
Nonprofit Compliance Obtain Certified Copies Private Investigator License Real Estate Licensing 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 18, 2021. Complete data last reviewed February 18, 2021.
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