RFA

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...

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...

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...

“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, ...

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 ...

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...

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...

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...

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...

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...

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 ...

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...