Utilization Review Organization Registration Guidelines Illinois Department of Financial and Professional Regulation Division of Insurance

What are Health Care Utilization Review Organizations?

A Health Care Utilization Review Organization (URO) is an entity that has established one or more utilization review programs, which evaluates the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities.  Not included in this definition are:

• persons providing utilization review program services only to the federal government;
• self-insured health plans under the Federal Employee Retirement Income Security Act of 1974 (ERISA). Note - Persons conducting a utilization review program on behalf of these health plans must register; and
• hospitals and medical groups performing utilization review activities for internal purposes. Note - hospitals or medical groups, conducting utilization review for another person must register

When must Health Care Utilization Review Organizations Register?

Beginning July 1, 2000, all UROs must register with the Director of Insurance. Registration of Illinois UROs is effective for a period of two years and must be renewed biennial. Each URO registration must contain a completed Application for Registration of a Utilization Review Organization (Section 5420 Exhibit D) and Utilization Review Organization Officers and Directors Biographical Affidavit (Section 5420 Exhibit E).

Beginning July 25, 2005, Illinois registered Health Care Utilization review Organizations which meet or exceed URAC's Health Utilization Management Standards, may also conduct a utilization review program for Worker Compensation Services. All such entities must indicate their intent to do so within Section 2 of their Application for Registration of a Utilization Review Organization (Section 5420 Exhibit D).

What is the registration fee for an Illinois Utilization Review Organization?

A registration fee of $3,000 must be submitted with each application or renewal, unless the URO holds a current accreditation with one or more of the following:

• American Accreditation Healthcare Commission (URAC)
• National Committee for Quality Assurance (NCQA)
• Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

in which case the registration and renewal fee will be $1,500. All checks or money orders must be made payable to the Director of Insurance, State of Illinois.

Mail Completed Applications to:

Illinois Division of Insurance
Utilization Review /Managed Care Compliance Unit
320 West Washington Street
Springfield, Il 62767-0001

ANY MATERIAL CHANGES IN YOUR URO APPLICATION MUST BE FILED WITH THE DIRECTOR WITHIN 30 DAYS OF THE CHANGE.

For questions or more information, please contact:

Kelly Reim
Insurance Analyst
Illinois Department of Financial and Professional Regulation
Division of Insurance
Utilization Review / Managed Care Compliance Unit
(217) 558-2309
(217) 557-8478 fax
kelly.reim@Illinois.gov