Utilization Review Organizations
Utilization review is conducted to determine the appropriateness of levels of treatment and of giving opinions as to the reasonableness of charges for diagnostic or treatment services of the licensees of certain licensing boards (e.g., Board of Medicine, Iowa Code Chapter 148; Board of Podiatry, Iowa Code Chapter 149; Board of Chiropractic, Iowa Code Chapter 151; and Board of Nursing, Iowa Code Chapter 152). The licensing boards can establish their own committees to do the utilization review, or they can designate other utilization organizations to do it for them. Under Iowa law, insurers or other plan providers are not permitted to conduct utilization reviews, either directly or indirectly, under a contract with a third party utilization review organization that does not meet requirements established for accreditation set by the utilization review accreditation commission or the national committee on quality assurance. Iowa Code chapter 514F and Iowa Administrative Code rule 191-70 provide more information about use and accreditation of utilization review organizations.
If you have a complaint about a utilization review organization, you may advise the Iowa Insurance Division of your concerns and request an investigation by completing this form.
Utilization Review Certification
Each year, prior to March 1, an entity conducting utilization review shall provide the commissioner with a certification that the entity is in compliance with Iowa Administrative Code chapter 191-70.
Please submit the certification documents to the division by clicking here.
Annual Reporting
A Utilization Review Organization must provide two annual reports as defined in Iowa Code Chapter 514F (This code chapter will be updated due to House File 303 as of July 1, 2025). The annual reports are due August 31st for information collected from July 1 through June 30. The first reports are due August 31, 2026. Annual reports must include all of the information required in Iowa Code Chapter 514F.
The Division is currently creating the required reporting templates and will provide updates to this website as soon as the reports are available for preview in OPTins. Utilization Review Organizations will be able to download copies of the annual report templates in OPTins and are required to submit completed reports through OPTins.
HOW TO SUBMIT ALL REPORTS THROUGH OPTins
The Iowa Insurance Division requires use of OPTins (Online Premium Tax for Insurance) for the submission of the Utilization Review Organization Annual Reports. If you do not have an OPTins account, contact the OPTins Marketing Team at optinsmktg@naic.org or call 816-783-8787. Setup of a new account takes 7-10 business days. If you already use OPTins, you do not need to set up a new account; just create a new filing for the Utilization Review Organization annual report
All annual reports and must be filed under the company name. If you are submitting a report for more than one company, they MUST BE filed individually.
We ask that you DO NOT mail any paper reports to the Iowa Insurance Division.
Questions: If further information is needed regarding a report, you may contact: producer.licensing@iid.iowa.gov