It’s something like a motto around here: Billing success starts with authorization success. Submitting a Request for Authorization (RFA) is the best investment a provider can make to guarantee payment for workers’ comp bills.
This has been the case since 2013, when Senate Bill 863 made RFAs mandatory.[1] Now, a new piece of legislation – Senate Bill 1160, covered extensively in this space – makes RFAs an indispensable part of lien claimant qualification, as well.
Remember, starting January 1, 2017, all medical treatment and med-legal lien claimants must file a lien declaration affirming that the claimant satisfies at least one of seven new lien claimant requirements. Of the seven, two prominently feature RFAs.
We’ll quote the relevant portion of the bill (Section 8, which amends Labor Code 4903.05) before examining the first of these requirements in greater detail.
For liens filed on or after January 1, 2017, any lien claim for expenses under subdivision (b) of Section 4903 that is subject to a filing fee under this section shall be accompanied at the time of filing by a declaration stating, under penalty of perjury, that the dispute is not subject to an independent bill review and independent medical review under Sections 4603.6 and 4610.5, respectively, that the lien claimant satisfies one of the following:
Once a claims administrator receives a compliant RFA from a provider, it must respond with a compliant and timely communication to that provider that approves, modifies, or denies the requested treatment.[3] Claims administrators communicate the decision within five business days, except in the case of an expedited or retrospective Utilization Review (UR) decision.
Keeping a record of the claims administrator’s receipt of the RFA is critical. DaisyBillers, in the RFA History page, you can find the precise date and time that the RFA decision is due back from the claims administrator, along with a fax receipt verifying delivery. An untimely response to an RFA invalidates the utilization decision and allows the WCAB to decide the treatment dispute.
We can’t stress this enough: RFAs are required, easy to track, and an approved RFA allows you to file a lien.
Authorized RFAs guarantee payment, and guarantee that you may file a lien under Section C.
Untimely responses to RFAs invalidate the utilization decision and allow the WCAB to decide the treatment dispute.
Every physician should invest in RFAs – they’re the most effective way to ensure payment.
[3] Prior to January 1, 2017, the claims administrator may also delay the requested treatment.
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