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IDOI provides requirements for Certification of Registration for a new Utilization Review Agent under IC 27-8-18 and applicable regulation IAC 760 1-46.
The following items must be submitted in order to register as an Utilization Review Agent. The appropriate forms can be completed and printed by clicking on the underlined item.
1. Application: Each question must be completed in full. If additional space is needed, attach a separate sheet of paper, properly signed.
2. Utilization Review checklist: Complete the “Located” column on the checklist with the section and page number of your submission where the item can be found. Attach supporting documentation. Please note that URAC accreditation does not waive any requirement for submission.Please note that URAC accreditation does not waive any requirement for documentation submission.
3. $150 Application Fee
The completed application, application fee, and supporting documentation should be sent to the following:
Indiana Department of Insurance
Attn: Utilization Review
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204