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IDOI > Financial Services > Renewal Registration Requirements > Utilization Review Utilization Review

IC 27-8-17

IDOI Rule 46

IDOI provide renewal requirements of Certificate of Registration for the Utilization Review Agent under IC 27-8-17 and applicable regulation IAC 760: 1-46.

The following items must be submitted in order to obtain a renewal of your Certificate of Registration. Please number each item in the upper right-hand corner to correspond with its number in this Schedule of Requirements.

1.      Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.

2.      A renewal fee of $100.00 will be invoiced during the month of May. Payment should be made in accordance with the invoice instructions and mailed to the post office box address.

Do not submit your renewal fee with the application material.

3.      If there have been any changes in your previously submitted documentation also complete the Utilization Review renewal checklist  and supporting documentation. Complete the “Located” column on the checklist with section and page number of your submission where the item can be found, for all items where documentation has changed. Mark all other items on the checklist N/C.

  • Medical claims review plan summary including written screening criteria and review procedures.
  • Toll-free telephone number, hours of operation, contact person and phone number.
  • Confidentiality procedure.
  • Orientation and training of personnel and categories of persons employed for medical review.
  • Statement from a licensed physician that determinations are reviewed with standards and guidelines approved by a licensed physician.
  • Copy of procedures and forms used for notification of determination as per IC 27-8-17-11.
  • Signed statement as to your cooperation with the Department of Insurance on investigation of complaints made to the Department.
  • Signed statement that you are in compliance with IC 27-8-17-19 and IC 27-8-17
  • EIN or FIN number.

URAC accreditation does not waive any requirement for documentation submission.

For any questions, contact Danielle Fuller at 317-232-4391 or dfuller@idoi.in.gov.

The completed application and information requested above should be sent to the following:

Indiana Department of Insurance
Utilization Review Specialist Company Compliance Services
311 West Washington Street, Ste 300