Request for Authorization
Oct 13, 2022
How "Fast-Track" UR Can Backfire for CA Providers
California’s “Fast-Track” Utilization Review (UR) initially sounded like good news for doctors who provide the first treatment following a work-related injury. ...
Jun 15, 2022
Sedgwick: Gruesome and Abusive IBR Games
In California workers’ comp, providers cannot rely on authorization to guarantee payment — despite what the law says. Today’s article shows exactly how a claims administrator...
Nov 30, 2021
10 Ways to Fix CA Workers' Comp
Today, the California Division of Workers’ Compensation (DWC) will host a virtual public meeting “to hear ideas to improve the efficiency and quality of care provided to inju...
Nov 11, 2021
The Hartford Ignores TWO California Laws
By insisting The Hartford owed no payment for authorized treatment provided outside the Medical Provider Network (MPN), The Hartford pooh-poohed a clear-cut Cal...
Oct 14, 2021
Zurich Refuses to Pay for Emergency Treatment
In a medical emergency, a doctor treats first and asks questions later. But in response to a medical emergency, Zurich refused to pay a doctor for suturing a lacerated finger...
Sep 21, 2021
Dollar Tree/Sedgwick Won’t Pay for Authorized Treatment
Authorization is, by definition, a promise.It’s the promise that, once a doctor obtains authorization from an employer to treat an injured worker, the employer will pa...
Sep 15, 2021
SCIF Hacks IBR by Switching (Incorrect) Denial Reason
There’s a serious inequity in the appeals process by which California workers’ comp providers can dispute incorrect reimbursement for authorized treatment. State Compensation...
Apr 24, 2020
CA: Authorization for Treatment Provided via Telehealth
When we published Telehealth Cheat Sheet: California Providers’ Guide, many providers reached out to us with questions regarding authorization requirements. For clarification...
Oct 12, 2018
CA: Employers 100% Responsible for UR Mistakes
In a much-anticipated ruling, California’s Supreme Court ruled that a secondary injury derived from an incorrect Utilization Review (UR) decision is compensable under workers...
Jun 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...
Jun 20, 2018
Data Show MPNs Do Not Benefit Employers
Medical Provider Networks (MPNs) allow employers to limit where employees may seek treatment for work-related injuries. Theoretically, the purpose of MPNs is to direct care w...
Jun 6, 2018
Do Not Send RFAs With Bills
When treating an injured worker, a provider must fax the Request for Authorization (RFA) to the fax number designated by the claims administrator. RFAs should never be sent w...