The Georgia Private Review Agent license
Private Review Agent
Decides whether somebody else's medical care was necessary. Georgia certifies rather than licenses it, and the certification turns on a written plan and a set of promises about how the reviewer is paid, including that nobody is paid more for saying no.
Course
None
This license has no pre-licensing course route.
Ways in
1
There is no state exam for this license.
Exam
n/a
Not required on any of the routes below.
Every way to qualify
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Route 1 File the utilization review plan and the conflict certifications
No state exam for this license
The plan and the people who run it
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A utilization review plan, any URAC or NCQA certification or a statement of where the applicant stands on getting one, a list of the type, qualifications and number of the personnel employed or contracted to perform reviews, and copies of the materials and notices designed to inform patients and health care providers of the plan's requirements.
and the promises about how it operates
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Quality assessment program documentation, written policies keeping representatives available to patients and providers at least five days a week in normal business hours, written confidentiality policies, a complaint system, and copies of every contract with a payor, employer or claim administrator certified to contain no incentive payment provision tied to reducing services, charges, length of stay or the use of alternative treatment settings.
$1,000 plus a $5 processing fee and any system fees. All filings moved to Sircon on 2025-07-01 and the Office reviews an initial certification or a recertification within ten days, closing an incomplete application after sixty days from the deficiency notice. The renewal is called a recertification and the reminder goes out about ninety days before expiry. There is no examination and no course. The Office lists the certification on its Limited Risk Entities page as "Utilization / Private Review Agents" and calls it a Private Review Agent Certification on the page itself.
Read at the Department on 2026-08-20
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No national seller sells a course for this certification. Nothing is examined: the certification is granted on a written plan and a set of certifications about how reviewers are paid.