Blog: Daisy News

News, data, & insights about workers' comp billing

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  • July 12, 2018

    RFA for Emergency Treatment in California Workers’ Comp

    First, let’s be clear that providers never have to wait for authorization before providing emergency treatment for an acute medical condition.

    Never.

    However, the provider must ultimately obtain authorization for all services, even when the injury is time-sensitive or a medical emergency. While the authorization and utilization review (UR) process should never be an obstacle to such treatment, there are mandated procedures and timelines for submitting the official Request for Authorization (RFA).  

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  • June 22, 2018

    Conditional Authorization: How MPNs Cheat Workers’ Comp Providers

    Medical Provider Networks (MPNs) are a drag on California workers’ compensation. Nominally designed to help employers control costs, MPNs rarely achieve more than throwing up obstacles to the treatment of injured workers, and cheating providers out of reimbursement — even for authorized services.

    Authorization, of course, is supposed to be final. But when claims administrators grant authorization on the condition that the treating physician be included in the employer’s MPN, they create opportunities to deny payment.

     

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  • April 25, 2018

    3 Facts About Automatic Authorization for Workers’ Compensation

     

    Recently, a DaisyBill client reached out with questions regarding automatic authorization. The source of the confusion was a slideshow presentation from the California Coalition on Workers’ Compensation (CCWC)’s 15th annual conference, held last July. The presentation contained no outright falsehoods, but used puzzling language and left out a key point regarding billing deadlines.

    Tellingly, the conference was sponsored by Sedgwick, the third-party claims administrator. Given claims administrators’ interest in keeping providers in the dark regarding the new rules, we thought we’d clear up some confusion.

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  • March 9, 2018

    Complete 2018 Automatic Authorization Guide for California Workers’ Comp

    Over the last several months, we blogged extensively (and hosted a free comprehensive webinar) on the new automatic authorization process for California workers’ comp.

    Here, we’ve assembled the most important rules and procedures into one convenient guide. Use this for quick and easy reference, and feel free to download and print the PDF version from our Webinar Library by clicking below:

    DOWNLOAD COMPLETE 2018 AUTHORIZATION GUIDE

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  • February 16, 2018

    Authorization/Utilization Review: Why Peer-to-Peer Calls Are a Bad Idea

    There’s been lots to say about authorization and utilization review (UR) this year, especially given the major changes to the process. However, one UR rule that remains the same in 2018 also remains sadly overlooked: those conducting UR on behalf of employers or insurers should not telephone providers for further information needed to make a UR decision.

    This practice is non-compliant, wasteful, and has the potential to compromise the integrity of a decision to approve, modify, or deny the requested treatment.

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  • February 9, 2018

    What’s New for Workers’ Comp in 2018: CA Senate Bill 1160

    In 2016 California passed Senate Bill 1160, which heralded significant workers’ compensation reform. SB 1160 outlined major changes to authorization, utilization review, lien filing, billing deadlines, and more. Some changes took effect in 2017, while others are newly effective, as of January 1 this year.

    Let’s take a look at the major changes SB 1160 brings to workers’ comp in 2018.

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  • 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.

    For our complete downloadable guide to automatic authorization in 2018, click here.

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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.

    For our complete downloadable guide to automatic authorization in 2018, click here.

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DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.