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Home > Companies > Company licensing > Utilization review agent
Utilization review agent
Health Care Service Utilization Review is governed by the provisions of N.D.C.C. § 26.1-26.4 and N.D. Admin. Code 45-06-10. The Century Code and Administrative Code can be accessed through the communications section of this website.

In order to conduct a utilization review in North Dakota, a utilization review agent must certify to the Insurance Commissioner that the agent is in compliance with the minimum standards set out in N.D.C.C. § 26.1-26.4-04. The utilization review agent must submit a complete application consisting of the following requirements:
  • Utilization Review Filing Report (SFN 18332)
  • Utilization Review Agent Certification (SFN 18378)
  • Description of the appeal procedures for utilization review determinations
  • A list of the third-party payers for whom the private review agent is performing utilization review in the state.
  • Copy of URAC or NCQA Accreditation - specifying the program, if applicable.
  • Provide the name of the physician, practitioner or psychologist that will be conducting the utilization reviews (North Dakota board certified).
  • Filing fee of $10.00 made payable to the North Dakota Commissioner of Insurance.
The Insurance Department will issue a letter of certification if the application is approved. An application may be filed at any time throughout the year. All applications and fees should be directed to:

Yvonne Keniston
ytkeniston@nd.gov
ND Insurance Department
State Capitol, fifth floor
Dept. 401
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
701.328.2440
701.328.4880 fax

Please note: Any material changes in the information submitted to this office, such as change in FEIN, name, address/contact, change in control, conversion, etc. must be filed with the Insurance Commissioner within 30 days of the change.

Annual renewal requirement

The certification form, Utilization Review Agent Certification (SFN 18378) must be filed with the Insurance Commissioner on or before March 1 of each calendar year accompanied by a $10 filing fee made payable to the North Dakota Insurance Commissioner.

Utilization review agents can review their status by accessing the home page after March 31st and clicking on "Search for an agent, agency or company". This will allow companies to find their current status with the North Dakota Insurance Department.


Please direct any questions to:

Yvonne Keniston
ytkeniston@nd.gov
ND Insurance Department
State Capitol, fifth floor
Dept. 401
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
701.328.2440
701.328.4880 fax

North Dakota Insurance Department
600 E. Boulevard Ave.
Bismarck, ND 58505-0320
Phone 701.328.2440
Toll free 800.247.0560
Fax 701.328.4880

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