La. Admin. Code tit. 37 § XIII-6205

Current through Register Vol. 50, No. 11, November 20, 2024

Section XIII-6205 - Authorization or Licensure as a URO

A. No health insurance issuer or entity acting on behalf of or as an agent of a health insurance issuer shall act as a utilization review organization unless licensed to do so by the commissioner. The license shall become effective upon approval by the commissioner and shall remain in effect, unless suspended or revoked by an action of the commissioner.

B. Entities who are not health insurance issuers but who are seeking to become licensed as a URO must complete and submit an application packet to the commissioner. The packet must include the application on the form approved and provided by the commissioner, payment of the initial fee per R.S. 22:821(B)(36) and all supporting documentation. Failure to submit all required documentation may result in processing delays or disapproval of the application. To obtain a copy of the URO application, visit www.ldi.la.gov/industry/company-licensing/application-forms.

C. Entities who are health insurance issuers and hold a valid certificate of authority in this state are not required to complete an application. However, the following documentation must be submitted to the commissioner:

1. a general description of the operation of the URO, including a statement that the URO does not engage in the practice of medicine nor acts to impinge or encumber the independent medical judgment of treating physicians or providers;

2. a copy of the URO's program description or procedures manual;

3. a sample copy of any contract, absent fees charged, for making utilization review determinations that is entered into with another health insurance issuer.

La. Admin. Code tit. 37, § XIII-6205

Promulgated by the Department of Insurance, Office of the Commissioner, LR 41:2173 (October 2015).

AUTHORITY NOTE: Promulgated in accordance with R.S. 22:2452.