Illinois Administrative Code
Title 50 - INSURANCE
Part 4520 - MANAGED CARE REFORM & PATIENT RIGHTS
Section 4520.130 - Registration of Utilization Review Organizations
Current through Register Vol. 48, No. 12, March 22, 2024
a) Registration: On or after July 1, 2000, a URO may not conduct utilization review for persons subject to Section 85 of the Act unless the URO has registered with the Director. An application for registration shall be made using the standard form available on the Department website (https://insurance.illinois.gov), and must be signed by an officer or director of the URO. Initial registration applications shall be deemed approved unless the Director finds the application to be noncompliant with either the standards set forth in Section 85 of the Act or this Part.
b) The application for registration shall include, but not be limited to, the following information: applicant's identifying and contact information; applicant's agent for service of process in Illinois; applicant's accreditation status; signed affirmation by an officer or director; and for each utilization review program: contact information and business hours; organization and governing structure; number of reviews in Illinois for the current and previous years; description of the grievance process; written policies and procedures for protection of confidential information; and biographical information for officers and directors. The Department will accept the biographical affidavit, and any supplement to that affidavit, that is obtained from the website of the National Association of Insurance Commissioners (NAIC) or the Department.
c) Fees: A URO must register with the Director every two years. A fee of $3,000 must be submitted with each application or renewal unless the URO is accredited by URAC (formerly Utilization Review Accreditation Commission), the National Committee for Quality Assurance (NCQA), The Joint Commission (JCAHO), or the Accreditation Association for Ambulatory Health Care (AAAHC), in which case the fee is $1500.
d) Any material changes in the information filed pursuant to this Part shall be filed with the Director within 30 days after the change. Loss of accreditation status will require re-registration and payment of a $3000 fee pursuant to subsections (a) and (b).
e) Renewals and Appeals: