Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.
IDOI provide renewal requirements of Certificate of Registration for the Utilization Review Agent under IC 27-8-17 and applicable regulation IAC 760: 1-46.
The following items must be submitted in order to obtain a renewal of your Certificate of Registration. The appropriate forms can be completed and printed by clicking on the underlined item.
1. Application: Each question must be completed in full. If additional space is needed, attach a seperate sheet of paper, properly signed.
2. $100.00 Renewal Fee: An electronic renewal notice will be sent by email approximately sixty days prior to the renewal date to the email address we have on file through SIRCON.
3. Utilization Review Renewal Checklist: If there have been any changes to previously submitted documentation, complete the checklist and include supporting documentation. Complete the “Located” column on the checklist for all items that have changed and for other items mark “N/C”.
URAC accreditation does not waive any requirement for documentation submission.
The completed application, renewal fee, and any supporting paperwork should be sent to the following:
Indiana Department of Insurance
Attn: Utilization Review
311 West Washington Street, Ste 300
Indianapolis, IN 46204-2787