Utilization Review Licensing in Georgia

Application for Certification as an IRO

$500

• A copy of the organization's independent review plan
• A written quality assurance mechanism in place that ensures the timeliness and quality of the reviews, the qualifications and independence of the expert reviewers, and the confidentiality of medical records and review materials.
• Copies of policies and any procedures ensuring compliance with all applicable state and
  federal laws and with the Rules to protect confidentiality of medical records and personal information.
• A listing of the number, type, and minimum qualifications of the personnel either employed or under contract to perform the independent review.
• A copy of written procedures used to determine whether physicians or other health care providers utilized by the independent review organization describe the personnel and the accrediting policies and procedures of the applicant.
• A completed profile for each expert reviewer and provider as outlined in the Rules.
• Biographical information about officers, directors and staff as detailed on the application.
• A copy of the most recent by-laws and articles of incorporation for the legal applicant.
• Evidence of the applicant's authorization to conduct business in that state of Georgia.
• A description of the existing or proposed organization and provide a copy of the organizational chart.
• A chart showing contractual arrangements of the independent review system.
• The names of each stockholder or owner of more than five percent of any stock or options.
• The name and type of business of each corporation or other organization that the applicant controls or is affiliated with and the nature and extent of the affiliation or control. Also provide a chart or list clearly identifying the relationship between the applicant and any affiliates.
• A list of any currently outstanding loans or contracts to provide services between the applicant and any affiliates or any officer of its affiliates.
• The names of any predecessor affiliates and /or companies, including trade names.

Renewal of Certificate of Registration for IRO

$250

Annually at least 90 days prior to the anniversary of registration.

Application for Certification as a Private Review Agent

$1,000

• Certified copy of entity formation documents including amendments
• Copy of bylaws, rules and regulations or similar documents regulating the affairs of the private review agent certified by the principal partners or the president and secretary and containing the corporate seal.
• Names, addresses, and titles of positions held by individuals who are responsible for the conduct of the affairs of the private review agent in Georgia.
• A copy of the biographical affidavit for each person listed as responsible for the conduct of the affairs of the private review agent.
• If using a DBA, a certified copy of the recorded application received from the Clerk of the Superior Court in the county where doing business.
• Some additional attachments as noted in the Checklist of Application Documents for Initial Certification of Private Review Agents

Application for Certification as a Private Review Agent (Renewal)

$500

Biennially by the date of issuance.

Annual Report Information for Utilization Review Activities

$0

Annually by March 1.

GAC § 120-2-58-.07

$0

Annually by March 1.

GAC § 120-2-58-.07