Application For Registration For Utilization Review Organization {C-39}

FORM C-39 - APPLICATION FOR REGISTRATION FOR UTILIZATION REVIEW ORGANIZATION. This form is an application for registering a Utilization Review Organization (URO) with the Tennessee Department of Workers' Compensation. A URO evaluates medical services for workers' compensation claims to ensure they meet necessary standards. This form requires the organization's name, address, contact details, and certification information, including the certification's issue and expiration dates. The applicant must submit supporting documents, such as an "Approved" certification letter from the Tennessee Department of Commerce and Insurance, and proof of certifications. The form is signed by the applicant to verify the accuracy of the provided information. www.FormsWorkflow.com