Utilization Review Licensing in South Dakota
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 South Dakota. For assistance with licensing, please contact us to learn about our software and managed license services.
South Dakota Independent Review Organization License
| Type of Review: | Medical Utilization Review Long Term Care Utilization Review |
| Agency: | South Dakota Department of Labor and Regulation - Division of Insurance |
| Law: | SD Admin Rules 20:06:53:55 |
Initial Registration
| Filing Method: | |
| Agency Fee: | $250 |
Registration Renewal
| Filing Method: | |
| Agency Fee: | $250 |
| Due: | Biennially |
South Dakota Utilization Review Organization (URO) Registration
Initial Registration
| Filing Method: | |
| Agency Fee: | $250 |
Registration Renewal
| Filing Method: | |
| Agency Fee: | $250 |
| Due: | Annually by July 1. |
South Dakota 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.
