Blog: Daisy News

News, data, & insights about workers' comp billing

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  • January 22, 2018

    2018 Authorization/Utilization Review: Major Changes Effective 1/1/2018 (Webinar 53: Fast-Track Utilization Review, 01.23.18)

    Senate Bill 1160 makes significant changes to the authorization and utilization review (UR) process, starting in 2018. New “fast-track” UR takes effect on January 1.

    Fast-track UR bypasses prospective utilization review by automatically approving the required treatment in many — but not all — circumstances. A set of specific conditions must exist in order for providers to bypass the usual UR process. The new process also changes the rules regarding authorization and billing for these encounters.

    DaisyBill will host a webinar on fast-track UR on February 6.

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  • January 12, 2018

    Authorization 2018: New Billing and RFA Deadlines

    The new “fast-track” automatic authorization process took effect on January 1, 2018. Under certain circumstances, some providers may provide “automatically” authorized treatment without submitting a prospective Request for Authorization (RFA). Of course, this new process is subject to new rules and conditions — including new deadlines for submitting an RFA and for submitting the corresponding billing.

    Today, we explore the timeframe requirements for all fast-tracked treatments. We're also hosting a free webinar on the fast-track process on Tuesday, February 6. 

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  • January 5, 2018

    Authorization: 6 Qualifying Conditions for Fast-track Automatic Authorization

    On January 1, 2018, the new “fast-track” automatic authorization takes effect. In certain cases, some providers will be able to provide treatment without first submitting a Request for Authorization (RFA) for utilization review, because the treatment is automatically authorized.  But like many things in workers’ compensation, this “automatic” authorization scheme comes with conditions, caveats, and important new rules.

    Today, we explore the 6 qualifying conditions when treatment is eligible for fast-track automatic authorization. We're also hosting a free webinar on the fast-track process on Tuesday, February 6. 

    Read more →

  • December 14, 2017

    In Workers' Comp, Authorization Is Final 

    Let’s be very clear: in the workers’ comp dialect of Legalese, “authorization” means guaranteed payment for approved services. Period.

    While one can imagine scenarios in which an insurer or employer’s claims administrator might want to change their mind, authorization can’t be undone so easily. Once a payor communicates a utilization review (UR) decision approving treatment, the provider has the green light. A recent incident involving one of our providers is a great example.

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  • October 12, 2017

    Just in Time: RFA and Utilization Review Timeframe Requirements

    In California, proper authorization is one of the most important factors for compliance in workers’ comp billing and payment. Legally, “authorization” is the insurer’s acceptance of liability to pay for treatment. The request for authorization (RFA) and utilization review (UR) process informs everything that comes later in the billing and payment cycle.

    Everyone involved needs to get it right.

    The RFA and UR process is the means by which the insurer and the treating physician agree on the medical necessity of treatment. It is how injured employees get treated and back to work, and how providers obtain proper reimbursement. The rules and regulations regarding this process are vast and complex. That’s why we’ve created this handy guide, including our table of RFA and UR Timeframe Requirements mandated by California law.

    Read more →

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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.

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