Request for Authorization

California - 3 Workers' Comp Authorization Myths, Debunked

Providers who treat injured workers have one simple, reasonable request: correct reimbursement. In helping providers to obtain correct reimbursement, we answer a daily...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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 ...

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...