Request for Authorization
Oct 22, 2019
Maximus & DWC Drop Ball on IBR Eligibility
California workers’ comp billing and payment regulations are a minefield of complications. That said, some rules are fairly simple, and should be immutable. For exampl...
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...
May 23, 2018
IMR Unlikely to Overturn UR Decisions
When a payor’s utilization review organization (URO) denies treatment recommended by an injured worker’s treating physician, the only recourse is for the injured worker to ap...
Mar 2, 2018
FYI: $10k of Treatment Authorized Before Claim is Accepted or Denied
When an employee files a workers’ compensation claim, the employer or insurer is immediately liable for the cost of all medically necessary treatment provided before the clai...
Dec 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 i...
Dec 1, 2017
2018 Authorization/Utilization Review: Major Changes Effective 1/1/2018
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. Fa...
Aug 4, 2017
Why the RFA System Is Broken
Every day, we hear from frustrated providers across California who are struggling with their Requests for Authorization (RFAs). Their RFAs take too long to submit, and often ...
Mar 31, 2017
3DCA Decision Places Emphasis on RFA Timelines
On Wednesday afternoon, the California 3DCA, or Third District Court of Appeal, issued a ruling in the Ramirez v. Workers’ Compensation Appeals Board case. This is an interes...
Dec 9, 2016
Authorization and Declaration II: More on RFAs and Liens Under SB 1160
You already know Requests for Authorization (RFAs) as the single most effective tool for guaranteeing payment. Now RFAs play a vital role in lien declaration, as well....