State of Connecticut
 
Connecticut Insurance Department

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:

CGS §38a-591a through §38a-591n and Insurance Department Regulations §38a-591-1 through §38a-591-11  – see Laws and Regulations

Fees:

Initial: $3,000.00
Reinstatement: $3,000.00
Renewal: $3,000.00
No pro-rating, non-refundable application fee.

Duration:

One (1) year. Renewal Applications are due each October 1st for a renewal effective January 31st. The NIPR System is not available for renewal September 1st.

How to Apply:

How to Renew:

How to Amend Lines of Authority:

Not applicable

How to Reinstate a License:

How to change License information: (ie.: demographics)

Update your License Information

Material changes to policies/letters 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 the license:

License Cancel/Termination, Submit request to: Marge.Breen@ct.gov




Connecticut Insurance Department
About Licensing Unit
Email: cid.licensing@ct.gov
Phone: 860-297-3845