Utilization Review Licensing in Nebraska

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Utilization review licenses and certificates are typically issued for organizations conducting either medical or workers’ compensation reviews. This guide contains information about utilization review in Nebraska. For assistance with licensing, please contact us to learn about our software and managed license services.

Nebraska Independent Review Organization Certification

Agency:Nebraska Department of Insurance
Law:

NE Stat. § 44-1312

Foreign Qualification is Prerequisite:No
Registered Agent (Special Agency) Required?No

Initial Registration

Instructions:

Licensing Application Guide

Filing Method:

Online

Agency Fee:

$100

Required Attachments:
  • Documentation that the applicant has received approval or accreditation by a nationally recognized private accrediting agency
  • A list of the principal officers of the entity responsible for its operation, management, and control

Registration Renewal

Instructions:

Licensing Renewal Guide

Filing Method:

Online

Agency Fee:

$100

Due:

Biennially by the date of issuance.

Nebraska Utilization Review Agent Certification

Type of Review:

Medical Utilization Review

Agency:Nebraska Department of Insurance
Law:

NE Stat. § 44-5416 et seq.

Initial Registration

Form:

Utilization Review Agent Application

Agency Fee:

$300

Notarization Required?:Required
Required Attachments:
  • Documentation that the applicant has received approval or accreditation by the American Accreditation HealthCare Commission/URAC, or a similar organization which has standards for utilization review agents that are substantially similar to the standards of the American Accreditation HealthCare Commission/URAC, and which has been approved by the director
  • A list of the principal officers of the entity responsible for its operation, management, and control

Registration Renewal

Agency Fee:

$100

Due:

Biennially by the date of issuance.

Notes:

There is no form, instead submit a statement describing any changes in information or documentation submitted with the initial application.

Nebraska Resources

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Adverse Determination - When a health care plan or utilization review program decides that a medical treatment or service is not necessary.

Concurrent Review - Utilization review that is conducted during a patient’s course of treatment.

External Review - When an independent review organization is consulted to appeal an insurance company’s adverse determination.

Independent Review Organization (IRO) - Unbiased third-parties that conduct utilization review.

Prospective Review - Utilization review that occurs prior to treatment.

Retrospective Review - Utilization review that occurs after treatment and often after payment.

Utilization Review - A system for evaluating the medical necessity, efficiency, and appropriateness of medical services.

Utilization Review Agent (URA) - An entity that conducts utilization review.

Utilization Review Plan - A document of the procedures used during utilization review.

Revised November 20, 2023. Complete data last reviewed February 18, 2021.
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