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.
CGS §38a-591 - see Laws and Regulations
Initial: $3,000.00Renewal: $3,000.00
One (1) year. Renewal Applications are due each October 1st for a renewal effective January 1st.
Utilization Review - Company License Application
Bulletin HC-86-16 - Licensing & Renewal Requirements For Utilization Review Companies
Submit request to: Marge.Breen@ct.gov
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