February 8, 2018
Treatments That Do NOT Qualify for Automatic Authorization in Workers’ Comp
Automatic authorization for California workers’ comp is in effect, but not all treatments qualify.
In fact, the Division of Workers’ Compensation (DWC) has specifically barred certain treatments from automatic authorization. In these cases, the usual Request for Authorization (RFA) and prospective utilization review (UR) remains required — with some exceptions. Since many of our recent webinar attendees asked about specific services, we thought a review of ineligible treatments was in order.
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February 7, 2018
“Automatic” Authorization, but Denied Bill? How to Appeal the Denial
The new “automatic” authorization process for workers’ comp is in effect, as of January 1. We’ve discussed this new system extensively on our blog and in our recent webinar, covering everything from eligibility to timeliness to new utilization review requirements. But what happens if the employer or insurer’s claims administrator denies payment for automatically authorized services rendered? Does the usual second review appeal process apply?
In short, authorized is authorized, automatically or otherwise — but in this case, there is a twist.
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