Submitting RFAs (California)

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Submitting RFAs (California)

Postby evalencia on Thu Jun 23, 2016 11:00 am

Hello, work-comp pro's. It seems to me there are some problems in our office regarding the way RFA's are sbumitted. We know that we have the information correct, but our process is to submit an RFA for every patient after the progress report is finalized, regardless of any prior authorizations or denials. We see close to 100 patients per day so you can imagine this is a bit hard to keep up with. My question is this:

Should we be submitting an RFA to utilization review/insurance every single time? If we have an authorization for a medication that was certified, let's say 06/23/16 - 08/23/16, can we wait until 08/23/16 before we submit another RFA? It is also my understanding that after the receipt of an IMR denial, we can send an RFA while checking the "resubmission" box as long as we have documented material change in facts.

It seems like we may be creating additional issues by submitting an RFA every time; perhaps these patients don't need to be denied medications as often as they are?

Would anyone share their process and what works for them? Are we way off base here or are we actually on the right track? Any advice would be much appreciated.

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Re: Submitting RFAs (California)

Postby vampireinthenight on Fri Jun 24, 2016 8:18 am

Should we be submitting an RFA to utilization review/insurance every single time?

Yeah, that is likely to really annoy some people and could have some inadvertent consequences. They should be resubmitted only at the expiration of the last one or with a material change in circumstances.
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