Utilization Review
May 22, 2023
RFA: The Easy Way to Manage UR Decisions
So many injuries. So many Requests for Authorization (RFAs). So many Utilization Review (UR) decisions to keep track of — and only so much time in a day.Rest easy, pro...
May 9, 2023
RFA: How Technology Can Document UR Decisions
For providers, workers’ comp’s biggest challenges are obtaining authorization for treatment, and getting paid for providing the authorized treatment. Both chall...
Apr 26, 2023
Video: 30-Second RFAs for CA Workers' Comp
Let’s face facts: treating injured workers is a massive administrative pain for California providers and their staff. And that pain starts with the mandated employer authoriz...
Feb 15, 2023
Data: CA UR Decisions 2022
One of the great sources of friction in California workers’ comp is the Utilization Review (UR) and treatment authorization process — the critical process that determines whe...
Dec 8, 2022
Providers Respond: How to Fix CA Workers' Comp
In advance of the public meeting recently held by the Division of Workers’ Compensation (DWC), daisyBill offered a few suggestions for improving California’s workers’ comp sy...
Oct 15, 2019
SB 537: California RFA and Utilization Review Data
Last week Gavin Newsom, who serves as Governor of California, signed SB 537 into law, thereby adding a new section 138.8 to the Labor Code. This new §138.8 requires the Depar...
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 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 9, 2018
Complete 2018 Automatic Authorization Guide for California Workers’ Comp
Over the last several months, we blogged extensively (and hosted a free comprehensive webinar) on the new automatic authorization process for California workers’ comp. Here, ...
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 15, 2018
How to Bill for Physician-Dispensed Pharmaceuticals
Payments for physician-dispensed drugs are some of the most misunderstood — and incorrectly denied — in workers’ compensation billing. Too often, the employer or insurer’s cl...