Utilization Review (Private Review Agent)
This program consists of registration of an agent who performs utilization review services for third-party payers
on a contractual basis for hospital (outpatient or inpatient) services. The registration process does not include
full-time employees, personnel, or staff of health insurers, health maintenance organizations, or hospitals, or
wholly owned subsidiaries thereof or affiliates under common ownership, when performing utilization review for
their respective hospitals, health maintenance organizations, or insurers of the same insurance group. Agents
contracted with the Federal or State government that perform utilization review of medicare or medicaid claims
or reviewing workers' compensation claims do not have to be registered under this section. Also, self-insurance
funds or service organizations performing reviews of claims pursuant to chapter 440, F.S. or part VII of chapter 626, F.S.
are not required to be registered under this section.
Initial/Renewal/Change of Ownership Registration Requirements
All applications for registration must be submitted with a biennial registration fee
of $514. There are no survey requirements.
To renew a current state registration that is due to expire, you must print the application
for registration form below and submit the completed form(s) with the renewal fee prior to
the expiration date of the registration. Renewal applications must be received by the Agency
at least 60 days in advance of expiration of a registration or a late fee will be assessed.
Required documentation/forms
Background Screening
Florida Department of Law Enforcement and FBI fingerprinting must be completed
by the administrator, managing employee, and any other similarly titled individual who is responsible for the daily operation of the facility. Background screening must be repeated
every five years, or sooner if there is a new hire. Please go to the background
screening section of this web site for additional documentation that must
be submitted with your application.
Statute/Rule Authority
Updated March 18, 2008
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