Free Webinar! 2020 CA OMFS Part 2: Changes to Physician, ASC, and Pathology Fee Schedules

Questions and Answers about RFAs for Workers' Compensation

Today’s questions and answers come from our webinar on Requests for Authorization (RFAs). Why do we have so many webinars on RFAs? Because successful RFAs guarantee payment and we think that RFAs are woefully under-utilized.

Providers who read this: file those RFAs!

Who can submit an RFA? Is it only the Primary Treating Physician or can a specialist or other Treating Physician also submit an RFA?

The DWC’s utilization review regulations do not specify that only the primary treating physician can submit the RFA; therefore, secondary treaters can also  submit Requests for Authorization.

Do I need proof of service with RFAs?

No, the regulations do not mandate RFA submittal with proof of service. However, at DaisyBill we recommend faxing the RFA and retaining the fax receipt as proof of submission. This is automatically documented in the RFA history in DaisyBill for use as proof if/when the claims administrator does not respond to an RFA in a timely manner.

Can I use the RFA form for 5307.11 contracts?

No, the RFA form should not be used to engage in an agreement pursuant to 5307.11. The RFA form should only be used for utilization review, which determines medical necessity but not the amount of payment.

Consult our workers’ comp FAQ for more information on 5307.11 contracts.