Utilization Review Company (URC)

Definition

UTILIZATION REVIEW (UR) – means the use of a set of formal techniques designed to monitor the use of, or evaluate the medical necessity, appropriateness, efficacy, or efficiency of, health care services, health care procedures or health care settings. Such techniques may include the monitoring of or evaluation of (A) health care services performed or provided in an outpatient setting, (B) the formal process for determining, prior to discharge from a facility, the coordination and management of the care that a patient receives following discharge from a facility, (C) opportunities or requirements to obtain a clinical evaluation by a health care professional other than the one originally making a recommendation for a proposed health care service, (D) coordinated sets of activities conducted for individual patient management of serious, complicated, protracted or other health conditions, or (E) prospective review, concurrent review, retrospective review or certification.

Applicable Statutes

C.G.S. §38a-591a through §38a-591n & Insurance Department Regulations §38a-591-1 through §38a-591-11 – see Laws and Regulations

Fees

Initial: $6,000.00
Reinstatement: $6,000.00
Renewal: $6,000.00
Note: Change in fee based on CT Public Act 22-84 effective 1/1/23.
No pro-rating, non-refundable application fee. Plus a nominal NIPR application fee

Duration

Two (2) years – Renewal Applications are due each October 1st for a renewal effective January 1st. The NIPR System is not available to input your renewal until early September.

How to Apply

How to Renew

How to Amend Lines of Authority

Not applicable.

How to Reinstate a License

How to change License information (i.e.: demographics)

Update your License Information (use to update contact name, email, telephone, addresses, unless residency or state of residency changes)

Material changes to policies, letters and criteria which must be reviewed:

Submit the revised redlined policies or letters by attaching in the NIPR warehouse for review. Submit an email to LHCompliance@ct.gov to advise that a material change has been added on the NIPR system in the NIPR warehouse.

Print a copy of the license

Search and print a license

Initial Education Requirements

Not applicable.

Waivers due to Designations

Not applicable.

Renewal Continuing Education (CE) Requirements

Not applicable.

Cancel License

License Voluntary – Surrender Request