You can now renew your URA certification online. Learn how by going to the URA renewals and updates webpage.
If the form is a fillable PDF, learn how to enable all fillable form features.
|TDI Form Number||Description||File Format||Language|
URA Application Form
Application to apply for URA Certification, renew a URA Certification or update a URA Certification.
Utilization Review Agent's (URA) Designated Contact for IRO Requests
Prior Authorization of Health Care Services
Texas Standard Prior Authorization Request Form for Prescription Drug Benefits
Sample URA Adverse Determination Notice, Health
Sample URA Adverse Determination Notice, Specialty Health
Sample URA Adverse Determination Notice, Workers Comp Net
Sample URA Adverse Determination Notice, Workers Comp Non-Network
For more information, contact: URAGrp@tdi.texas.gov