Private Review Agent Application Requirements

Read the following requirements to obtain a private review agent license:
  • Notification of an adverse decision by the private review agent must be provided to the insured or other party designated by the insured within five business days either by telephone or fax.
  • Private review agents must have written procedures to assure that utilization reviews are conducted in a timely manner and for appeals of denials of certification.
  • Private review agents must make a certification determination within two working days of receipt of the necessary information and must make a certification determination of an extended stay or additional service within one working day of receipt of the additional information. Private review agents must not routinely conduct daily review on all such stays.