Utilization Review

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...

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...

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...

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...

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, ...

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...

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...

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 ...