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Texas Department of Insurance
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URA Renewal Application Instructions

  1. Read applicable laws and rules.
  2. Read all instructions on the application.
  3. Submit complete application Do not leave blanks.
  4. Complete pages one and two.
  5. Read the required application exhibits on page four of the application under “Renewal Application Only – Required Application Exhibits.”
  6. Submit the required application exhibits. Do not submit substitute documents.
  7. Submit all required application exhibits. You are responsible for functions you delegate to other entities or individuals.
    1. Categories of Personnel (28 TAC 19.1706(c) and (e) and 19.2006(c))
      1. Name
      2. License type
      3. Texas license number
      4. State of licensure
      5. Qualifications to perform the utilization review
    2. Template Letters
      1. Initial adverse determination letter (28 TAC 19.1709 (b)(1)-(9))
      2. Appeal acknowledgement letter (28 TAC 19.1711 (a)(3))
      3. Appeal determination letter (28 TAC 19.1711 (a)(8))
  8. We must receive your application and fee no later than the expiration date of your license.
  9. Do not submit material changes with renewal applications. Submit materials changes with update applications.
  10. You must attest that the template letters you submit with your application were approved by TDI and that you only utilize the approved letters to issue adverse determinations to involved parties. Submit the template letters that you are currently issuing to the involved parties.

For more information, contact:

Last updated: 3/4/2022