Utilization Review Organization Registration Guidelines

Illinois Department of Insurance

What are Workers' Compensation Utilization Review Organizations?

A WorkersCompensation Utilization Review Organization (URO) is an entity which evaluates the proposed or provided health care services to determine the appropriateness of both the level of health care services medically necessary and the quality of health care services provided to a patient, including evaluation of their efficiency, efficacy, and appropriateness of treatment, hospitalization, or office visits based on medically accepted standards. The evaluation must be accomplished by means of a system that identifies the utilization of health care services based on standards of care or nationally recognized peer review guidelines as well as nationally recognized evidence based upon standards as provided in the Act. Utilization techniques may include prospective review, second opinions, concurrent review, discharge planning, peer review, independent medical examinations, and retrospective review. Retrospective review shall be applicable to any service rendered on or after July 20, 2005. Workers Compensation Utilization Review does Not include the prospective review of:

• Necessary first aid or
• Emergency treatment

When must Workers' Compensation Utilization Review Organizations Register?

On or after July 1, 2006, 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 2905 Exhibit A) and Utilization Review Organization Officers and Directors Biographical Affidavit (Section 2905 Exhibit B).

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 the American Accreditation Healthcare Commission (URAC) 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 Department 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 Smith
Insurance Analyst
Illinois Department of Insurance
Utilization Review / Managed Care Compliance Unit
(217) 558-2309
(217) 557-8478 fax
kelly.smith@Illinois.gov