Utilization Review Licensing in Nevada

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

Nevada Independent Review Organization Registration

Type of Review:

Medical or Workers' Compensation Utilization Review

Agency:Nevada Division of Insurance
Law:

NRS § 616A.469

Initial Registration

Form:

Uniform Application for Business Entity License/Registration

Agency Fee:

$460 for a health review organization or $660 for a combined health and workers compensation review organization.

Required Attachments:
  • Written statement, written summary of procedures, and written affidavit required by NAC 683A.600
  • Proof of certification or accreditation by a nationally recognized private accrediting entity (if applicable)
  • A copy of the certification or accreditation standards of the accrediting body
  • A copy of the most recent review of the external review organization conducted by the accrediting body
  • The schedule of fees that the external review organization will charge to conduct an external review

Registration Renewal

Form:

Uniform Application for Business Entity License/Registration (Renewal)

Agency Fee:

$460 for a health review organization or $660 for a combined health and workers compensation review organization.

Due:

Biennially by the date of issuance.

Nevada Utilization Review Agent Registration

Agency:Nevada Division of Insurance
Law:

NRS § 683A.378

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

Initial Registration

Form:

Application for Certificate of Registration for Utilization Review

Agency Fee:

$310

Required Attachments:
  • A summary of the plan for utilization review including procedures for appealing determinations made through utilization review

Registration Renewal

Form:

Application for Certificate of Registration for Utilization Review (Renewal)

Agency Fee:

$310

Due:

Annually by March 1.

Nevada 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 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 February 18, 2021. Complete data last reviewed February 18, 2021.
Stay Informed
Get our industry-leading insights, research, and educational content first!
Contact
Contact
Better Business Bureau logo
Trustwave logo
© 2012 - 2021 Harbor Compliance. All rights reserved. Harbor Compliance does not provide tax, financial, or legal advice. Use of our services does not create an attorney-client relationship. Harbor Compliance is not acting as your attorney and does not review information you provide to us for legal accuracy or sufficiency. Access to our website is subject to our Terms of Use and Service Agreement.
Terms of Service Privacy Policy Secure Shopping