The North Dakota Utilization Review Agent license
Utilization Review Agent
Decides whether somebody else's medical care was necessary and appropriate. North Dakota certifies rather than licenses it, annually, and neither the chapter nor the Department's fee schedule prices the filing. The qualification is not the agent's at all: the reviews have to be made by a physician licensed by the North Dakota board of medicine or a psychologist licensed by the state board of psychologist examiners.
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 Certify to the commissioner each year
No state exam for this license
Reviewer
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a physician holding a current license from the North Dakota board of medicine, or, where appropriate, a psychologist holding a current license from the state board of psychologist examiners, named to the Department as the person who will conduct the reviews
and appeal procedure
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A written description of the appeal procedure by which an enrollee or the provider of record may seek review of a determination, including an expedited route, with every refusal on appeal made by a physician or licensed psychologist.
and who is being reviewed for
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A list of the third-party payers the agent performs utilization review for in North Dakota, kept current within thirty days of any material change.
N.D.C.C. 26.1-26.4-03 puts the act on the agent rather than on the regulator: an agent "may not conduct utilization review in this state unless the utilization review agent has certified to the commissioner in writing that the agent is in compliance with section 26.1-26.4-04", annually on or before 1 March. The Department issues a letter of certification when it approves the filing, and asks for the two forms, the appeal procedure, the payer list, a copy of any URAC or NCQA accreditation, and the name of the reviewing physician or psychologist. There is no examination and no course, and no fee for it appears in 26.1-01-07 or on the Department's fee page. The minimum standards at 26.1-26.4-04 include staff available on a toll-free line at least forty hours a week and a telephone system that takes calls outside those hours and returns them within two working days. Chapter 26.1-26.4 applies to grandfathered health plans unless the insurer or the agent extends the protections of 26.1-36-47 to them.
Read at the Department on 2026-08-20
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North Dakota sets no examination and no course for the certification, and what qualifies the work is a medical or psychology license issued by another board entirely. No national seller prices a North Dakota product for it.