Request For Authorization and Utilization Review in California Workers' Comp

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Copyright 2015 RateFast Speed Seminar RFA’s and the Utilization Review Process

Transcript of Request For Authorization and Utilization Review in California Workers' Comp

RateFast Speed SeminarRFAs and the Utilization Review Process

Copyright 2015

Define:

An RFA is a standardized form which includes a diagnostic code of the treatment being requested. RFAs are created as a sister to a Doctors First, PR-2, or PR-4 report and sent to the the Utilization Review (UR) department.

UR Checklist:

Thoroughly complete RFAFull medical report attached with RFAPatients medical history

Problem Solving

Question: You are requesting authorization for a treatment that the patient has already used. What should your report include? Answer:Functional ImprovementCompliance with Current TreatmentsWorsening of Condition

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Copyright 2015

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