A. An applicant for a certificate shall: 1. Submit an application to an Insurance Commissioner; and 2. Pay to the Commissioner an application fee in an amount of Five Hundred Dollars ($500.00), which shall be sufficient to pay for the administrative cost of the certification program and any other cost associated with carrying out the provisions of the Hospital and Medical Services Utilization Review Act. B. The application shall: 1. Be on a form approved by the Commissioner and accompanied by any supporting documentation that the Commissioner requires; and 2. Be signed and verified by the applicant.
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