What is utilization review?
Utilization review is defined as a system for reviewing the necessary, appropriate, and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients. §38.70.10(1)

Utilization Review

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1. What is utilization review?
2. What is a private review agent?
3. Who is subject to the state’s utilization review laws?
4. Is it required for a private review agent performing utilization review on single-employer, self-insured health plans to obtain a license?
5. Is the license transferable?
6. Where can I find the laws and regulations that govern utilization review and private review agents?
7. What are the licensing requirements to become licensed as a utilization review and private review agent?
8. How often must licensure be renewed?
9. What are the licensure fees (initial and renewal)?
10. When does a utilization review and private review certificate of license expire?
11. Does South Carolina recognize Utilization Review Accreditation Commission (URAC) accreditation?
12. Are there any other requirements of utilization review and private review agents?
13. Where do you file complaints?