RFA
Feb 16, 2018
Authorization/Utilization Review: Why Peer-to-Peer Calls Are a Bad Idea
There’s been lots to say about authorization and utilization review (UR) this year, especially given the major changes to the process. However, one UR rule that remains the s...
Feb 9, 2018
What’s New for Workers’ Comp in 2018: CA Senate Bill 1160
In 2016 California passed Senate Bill 1160, which heralded significant workers’ compensation reform. SB 1160 outlined major changes to authorization, utilization review, lien...
Feb 8, 2018
Treatments That Do NOT Qualify for Automatic Authorization in Workers’ Comp
Automatic authorization for California workers’ comp is in effect, but not all treatments qualify. In fact, the Division of Workers’ Compensation (DWC) has specificall...
Feb 7, 2018
“Automatic” Authorization, but Denied Bill? How to Appeal the Denial
The new “automatic” authorization process for workers’ comp is in effect, as of January 1. We’ve discussed this new system extensively on our blog and in our recent webinar, ...
Feb 1, 2018
Fast-Track UR for Workers’ Comp: New Rules for Entities Conducting UR
We spent the last few weeks bringing readers up to speed on the new “automatic” authorization and “fast-track” utilization review (UR) process for workers’ comp. While we’ve ...
Jan 12, 2018
Authorization 2018: New Billing and RFA Deadlines
The new “fast-track” automatic authorization process took effect on January 1, 2018. Under certain circumstances, some providers may provide “automatically” authorized treatm...
Jan 5, 2018
Authorization: 6 Qualifying Conditions for Fast-track Automatic Authorization
On January 1, 2018, the new “fast-track” automatic authorization takes effect. In certain cases, some providers will be able to provide treatment without first submitting a R...
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...
Nov 16, 2017
5 Strategies to Prevent Denied Work Comp Bills
California does not make it easy for work comp providers to get paid. The time and effort necessary to obtain proper reimbursement is an unfortunate reality of a system weigh...
Nov 10, 2017
How It Works: Independent Medical Review (IMR)
When the claims administrator representing the insurance company, employer, or TPA denies a valid, compliant Request for Authorization (RFA), what’s a work comp provider to d...
Nov 9, 2017
FYI: Claims Admin Not Required to Use RFA Form
A provider’s office recently asked if claims administrators must sign and return the Division of Workers’ Compensation (DWC)’s official RFA form when approving the requested ...
Oct 12, 2017
Just in Time: RFA and Utilization Review Timeframe Requirements
In California, proper authorization is one of the most important factors for compliance in workers’ comp billing and payment. Legally, “authorization” is the insurer’s accept...