Utilization Review Forms

An organization seeking initial certification or renewal of a current certification, may download the necessary forms from this site. Forms may be mailed to:

Managed Care Compliance
Bureau of Health Provider Standards
Alabama Department of Public Health
The RSA Tower, Suite 734
Physical Address: 201 Monroe Street, Montgomery, AL 36104
Mailing Address: P. O. Box 303017, Montgomery, AL 36130-3017
Phone: (334) 206-5178
Fax: (334) 206-2067

Please consult the Utilization Review Law for information regarding those organizations requiring certification, or call (334) 206-5178.

Initial Certification Application

Organizations holding certification from Utilization Review Accreditation Commission (URAC) and seeking initial certification in Alabama must submit (with original signatures) the following forms:

• UR Application
• Attachment A - Additional UR Sites
• Copy of current URAC Certificate specific to Health Utilization Management Standards

Non URAC accredited organizations must submit (with original signatures) and a check for $1,000 made payable to the Alabama Department of Public Health, the following forms:

• UR Application
• Attachment A - Additional UR Sites
• Policy and Procedure Checklist
• $1,000 fee

Renewals

Prior to the expiration of an Alabama certificate, organizations will be notified by Public Health to submit the following:

Non URAC accredited organizations must submit the following forms:

• Renewal Form (Non URAC)
• Attachment A - Additional UR Sites
• Policy and Procedure Checklist
• Annual Policy Attestation (Non URAC)

URAC accredited organization must submit the following forms:

• Renewal Form (URAC)
• Attachment A - Additional UR Sites
• Copy of current URAC Certificate specific to Health Utilization Management Standards

Organizations may download the required forms and submit renewal information in advance of Public Health's notification.