New insurers who write auto insurance in Michigan will receive a Welcome Letter via email from the Department of Insurance and Financial Services (DIFS) that provides instructions on how to submit an application for unconditional certification of the insurer’s auto insurance utilization review (UR) program. Insurers must apply for initial unconditional certification within 60 days of the correspondence.
Insurers must complete an Application for Unconditional Certification of Auto Insurance Utilization Review Program (FIS 2362) form and email the application and all required supporting documentation to DIFS-URCertification@michigan.gov. While submission through email is preferred, applications and supporting documentation may be submitted through U.S. postal mail; however, the auto insurer is responsible for accounting for longer processing times for the application and supporting documentation to reach DIFS. Mailed applications and supporting documentation can be sent to: DIFS, PO Box 30220, Lansing, MI 48909-7720. If an auto insurer elects to send an application and supporting documentation to DIFS via USPS Overnight services, it should be addressed to: DIFS, 530 W. Allegan Street, 7th Floor, Lansing, MI 48933. DIFS does not accept applications via fax.
Required Documentation
Auto insurers must submit copies of any written policies, procedures, and/or forms created for the purpose of its UR program. Supporting documentation should include an explanation as to how the insurer’s UR program complies with Rule 66 of the Administrative Rules, including the insurer’s:
Contracting with a Medical Review Organization (MRO)
An insurer who uses an MRO (or multiple MROs) remains responsible for complying with the Administrative Rules. Therefore, insurers who contract with a MRO should submit to DIFS copies of any written policies, procedures, or forms created for the purposes of their UR program(s).
Following review of the auto insurer’s application and supporting documentation, DIFS will provide a notice of either unconditional or conditional approval of the auto insurer’s utilization review program via the email address listed on the application.
The DIFS’ Director is required to issue a certification (unconditional or conditional) of the insurer’s UR program no later than 90 days after the insurer’s application for unconditional certification and all required supporting documentation is received by DIFS. If additional time is needed, the Director may extend the period for review by an additional 30 days upon written notice to the insurer.
Unconditional certification is granted when an auto insurer has satisfied all required components of the UR program. An unconditional certification is valid for a period of 3 years; however, the Director may at any time change an unconditional certification to a conditional certification if the Director determines that an insurer has failed to comply with any of the Administrative Rules.
Conditional certification occurs when the Director determines that the auto insurer or other entity does not substantially satisfy the required UR program criteria. In the event that an auto insurer’s proposed utilization review program does not satisfy all of the required components outlined in the administrative rules, the auto insurer will receive a Notice of Corrective Action Required for Certification via email from DIFS along with a Corrective Action Attestation form. The auto insurer will be required to email the signed Corrective Action Attestation form to DIFS-URCertification@michigan.gov within 7 days of the date of the notice. The conditional certification is permitted for a maximum of 1 year. All deficiencies must be resolved before reapplying for unconditional certification.
Once certification has been issued, see the Maintaining Certification page for ongoing requirements.
