Missouri Revised Statutes Title XXIV. Business and Financial Institutions § 374.503. Certificate required for utilization review agents, exceptions

1. A utilization review agent may not conduct utilization review in this state unless the Missouri department of commerce and insurance has granted the utilization review agent a certificate.

2. No certificate is required for those review agents conducting general in-house utilization review for hospitals, home health agencies, clinics, private offices or any other health facility or entity, so long as the review does not result in the approval or denial of payment for hospital or medical services for a particular case.