Insurance License Hub

The Tennessee Utilization Review Agent license

Utilization Review Agent

Decides whether a health care service a Tennessean has been recommended will be paid for. Tennessee certifies rather than licenses it, once a year, and an agent that holds a national accreditation pays nothing while one that does not pays $1,000.

Course

None

This license has no pre-licensing course route.

Ways in

2

None of them requires a state exam, because this license has none.

Exam

n/a

Not required on any of the routes below.

Every way to qualify

More than one route leads to this license, and which one you take changes what you study and whether you sit the exam. There is no pre-licensing course among them: this license is qualified for by a designation already held or applying for it with no examination anywhere.

  1. Route 1 Pay the fee instead

    No state exam for this license

    Fee in place of accreditation

    • A $1,000 payment to the Department, required only of an entity that is not URAC or NCQA accredited.

    and appeals procedures

    • A separate attachment setting out the agent's appeals procedures, as Tenn. Code Ann. 56-6-704 requires, and a signed certification of compliance with the minimum standards of Tenn. Code Ann. 56-6-705.

    The $1,000 is the price of not being accredited rather than a filing fee, which is why an accredited agent files the same form and sends no money. A company that performs workers' compensation utilization review in Tennessee has to deal with the Bureau of Workers' Compensation as well, and the Department's own instructions send it there rather than answering for it.

    Read at the Department on 2026-08-20

  2. Route 2 File an accreditation

    No state exam for this license

    Accreditation

    • URAC Utilization Review Accreditation Commission accreditation, evidenced by a valid certificate filed with the annual application, from URAC

    • or

      NCQA National Committee for Quality Assurance accreditation, evidenced by a valid certificate filed with the annual application, from National Committee for Quality Assurance

    and appeals procedures

    • A separate attachment setting out the agent's appeals procedures, as Tenn. Code Ann. 56-6-704 requires, and a signed certification of compliance with the minimum standards of Tenn. Code Ann. 56-6-705.

    The Health Care Service Utilization Review Act application is due annually on or before 1 July, and it is a certification to the Commissioner rather than a license application: the agent certifies its own compliance and attaches its appeal procedures. An accredited agent files the certificate and pays nothing. Any material change has to be filed within thirty days under 56-6-704.

    Read at the Department on 2026-08-20

Tennessee sets no examination and no course of its own here, and the two qualifications it will take are national accreditations awarded to organizations rather than to people. No national seller prices a product for it.