Utilization Review Licensing in Oregon

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

Oregon Independent Review Organization Registration

Not required



Utilization Review licensure is not required on the State level in Oregon.

There is no registration requirement for IROs in Oregon, however, annual reports must be filed with the Division of Financial Regulation.

More information: Oregon Division of Financial Regulation

Supplemental Reporting
External Review Annual Summary

Agency Fee:

$0

Due:

Annually by March 31.

Law:

OAR 836-053-1360

Notes:

Contact the division for a reporting form.

Oregon Utilization Review License

Not required



Utilization Review licensure is not required on the State level in Oregon.

There is no utilization review license in Oregon, but insurers that require pre-authorization for treatment are required to file an annual summary relating to the insurer's utilization review policies.

More information: Oregon Division of Financial Regulation

Oregon 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 File Articles of Incorporation 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 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 22, 2021. Complete data last reviewed February 22, 2021.
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