Utilization Review Forms

Documents, Forms and Law, Rules and Regulations regarding Private Review Agents under O.C.G.A. Chapter 33-46.

The following documents and forms are necessary for persons conducting Utilization Review activtities as defined in O.C.G.A. Section 33-46-2 and for the limited purposes as described in O.C.G.A. Section 33-46-1
Form Number: GID-057-LH-UR
  Title: Application For Certification as a Private Review AgentPublished: 2008
  Description: Application For Certification as a Private Review Agent.

Form Number: GID-065-LH-UR
  Title: Biographical AffidavitPublished: 2008
  Description: Biographical Affidavit

Form Number: GID-072-LH-UR
  Title: Checklist of Application Documents for initial Certification of Private Review AgentsPublished: 2008
  Description: Checklist of Application Documents for initial Certification of Private Review Agents.

Form Number: GID-072-LH-UR checklist
  Title: Checklist of Application Documents for Recertification of Private Review AgentsPublished: 2008
  Description: Checklist of Application Documents for Recertification of Private Review Agents

Form Number: GID-073-LH-UR
  Title: Annual Report Information for Utiltization Review Activities fot he Year Ended ...Published: 2008
  Description: Annual Report Information for Utiltization Review Activities fot he Year Ended ...

Form Number: PRA Cover Letter
  Title: PRA Cover LetterPublished: 2009
  Description: PRA Cover Letter

Form Number: Provider Instructions
  Title: Provider InstructionsPublished: 2009
  Description: Please use this Provider Complaint Form when Mailing your Insurance issues into the Department.
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PRINTED ON 3/15/2010 1:47:51 AM