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Utilization Review Guide, A State Legal Guide, 2024 Edition

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The "Utilization Review Guide" is a 51-state compilation of statutes and regulations addressing the relationship of utilization or private review agents with health care providers, enrollees, health insurers, and state regulators, such as the insurance, public health, and workers’ compensation departments.


The guide addresses:


  • Utilization Review Agent Duties
  • Application/Certification Requirements
  • Grounds for Certification Denials
  • Notice of Change Requirements
  • Recordkeeping and Reporting Requirements
  • Renewal Requirements
  • Confidentiality Requirements
  • Complaints
  • Exemption Criteria
  • Prohibitions
  • Waivers
  • Deadlines
  • Penalties
  • Appeal Procedures

The UR Guide also includes hyperlinks to more than 100 utilization review forms.

The guide exceeds 1,400 pages and is intended for informational purposes only. It should not be construed as the rendering of legal advice. Due to the complexity of utilization review laws and regulations, you should consult with your legal counsel to ensure compliance with state laws and any associated rules or regulations.

As an electronic subscriber, you will receive notice of any statutory/regulatory changes for a year. Notice of changes will be emailed to the email used to purchase this product.

The guide is non-returnable and non-refundable once purchased.

You will get a PDF (12MB) file