DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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DEPARTMENT OF INSURANCE

Utilization Review / Independent Review Entities

The Utilization Review Agent category identifies forms that are required for an application or renewal of registration to conduct utilization reviews in Kentucky.

The Independent Review Entities category identifies forms that are required for certification to conduct external reviews of disputes between a covered person and health benefits plans in Kentucky.

Utilization Review Entities

2024 Utilization Management Review Guide- Full Review - 650K

HIPMC-UR-1 - Utilization Review Registration Application - 315K

HIPMC-UR-2 Utilization Review Annual Report - 188K

HIPMC-MD-1 - Medical Director Form - 83K

2020 Utilization Management Limited Self-Funded Review Guide Interactive - 360K

Utilization Review Training FAQs - 173K

Utilization Review Training Presentation Slides - 3M

Independent Review Entities

IRE Certification Review Guide - 410K

HIPMC-IRE-1 - Application for Certification of an Independent Review Entity - 271K

HIPMC-IRE-2 - Assignment of Independent Review Entity Form - 129K

HIPMC-IRE-3 - External Review Decision Notification Form - 100K

HIPMC-IRE-4 - Data Reporting For Independent Review Entities - 98K

HIPMC-IRE-5 - Approval of an External Review Fee in excess of $800 - 94K

HIPMC-IRE-6 - External Review Information Face Sheet - 139K

Independent Review Information - List of IRE's certified to perform external reviews - 120K

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