Utilization Review Licensing in Oregon
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 Oregon. For assistance with licensing, please contact us to learn about our software and managed license services.
Oregon Independent Review Organization Registration
Not required
Utilization Review licensure is not required on the State level in Oregon.
There is no registration requirement for IROs in Oregon, however, annual reports must be filed with the Division of Financial Regulation.
More information: Oregon Division of Financial RegulationSupplemental Reporting
External Review Annual Summary
| Agency Fee: | $0 |
| Due: | Annually by March 31. |
| Law: | OAR 836-053-1360 |
| Notes: | Contact the division for a reporting form. |
Oregon Utilization Review License
Not required
Utilization Review licensure is not required on the State level in Oregon.
There is no utilization review license in Oregon, but insurers that require pre-authorization for treatment are required to file an annual summary relating to the insurer's utilization review policies.
More information: Oregon Division of Financial RegulationOregon Resources
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.
