If you are a medical professional working in California workers’ compensation, then you will probably need to prescribe treatment or diagnostic testing for your patients.
When you’re working in California work comp, all treatment, testing, and other medical services must be authorized by the employer’s insurance administrator. To request authorization, you need to submit a Request for Authorization (or RFA). The RFA is a written request for treatment, diagnostic testing or other medical services for the injured worker.
Anybody can fill out a form. But it takes a true professional to complete an RFA form with all the information that insurance administrators need.
If you don’t complete an RFA form correctly, then your treatment authorization may be delayed, or not approved at all.
But you can easily submit a RFA that will give insurance administrators all of the information they need. You just need to cover all the bases by following a few simple steps.
How to Correctly Submit a Complete RFA in 8 Easy Steps
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Get the correct RFA form from the DWC website, here: https://www.dir.ca.gov/dwc/DWCPropRegs/IMR/IMRFormRFAClean.pdf
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In the top box of the form, check the reason for the RFA.
- Check “New Request” for all treatment that you have not previously requested.
- Check “Resubmission – Change in Material Facts” if new information is available about the employee’s medical condition.
- Check “Expedited Review: Check box if employee faces an imminent and serious threat to his or her health” if the request is urgent–but not life threatening. (If the request is life threatening, and the employee requires hospitalization or emergency surgery, then submit a concurrent RFA.)
- Check the “Check box if request is a written confirmation of a prior oral request.” if you have spoken with the claims adjuster, and you have agreed that the employee needs care and that the treatment will be approved. For example, if the employee requires immediate surgery or medication, and the adjuster verbally approves the treatment, you will still need to submit an RFA.
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Complete the rest of the form by providing basic information about the injured worker.
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In the “Requested Treatment” section, ensure that you give all details about the treatment you’re requesting in the “Other” column. For example, if you’re requesting physical therapy, then make sure that you indicate the amount of treatments; if you’re prescribing medication, then specify the dosage and refills.
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If you’re the treating physician, then sign the RFA. If you’re not the treating physician, make sure you get his or her signature.
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Submit the Request For Authorization form with the visit report (the Doctor’s First Report, PR-2 report, etc.) via fax or email. If you don’t submit the RFA with the visit report, then the RFA will likely be returned to you.
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You should receive your approved or denied RFA within 14 calendar days after you submit it. If you don’t, then contact the insurance administrator.
