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Overview The Request for Authorization for Medical Treatment DWC Form RFA is required to initiate the utilization review process required by Labor Code section 4610. Routing Information The DWC Form RFA can either be mailed or faxed to the claims administrator. The requesting provider must complete 1 the patient s name date of birth date of injury employer and claim number 2 the claims name practice name address telephone number fax number specialty state license number and National Provider ID ...

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What RFA 2?

The RFA-2 is a New York State Workers' Compensation Board form. Specifically, it is a \u201cRequest For Further Action\u201d by the carrier or employer and can be found here. This form would be filed by the carrier or employer when a need for a hearing arises.

What is a 5021 form?

Every physician who treats an injured employee must file a complete Form 5021 Doctor's First Report of Occupational Illness or Injury (DFR) with the employer's claims administrator within five days of the initial examination.

What is an RFA authorization?

An RFA is a form that the doctor is required to use to request treatment, diagnostic tests or other medical services for an injured worker. If the treatment request was first made verbally, it must be confirmed in writing.

How long is utilization review Authorization good for?

If there is a utilization review denial of treatment, an injured worker can appeal the denial of workers comp benefits. Absent a change in circumstances, a utilization review denial is valid for twelve months.

What does RFA mean in workers comp?

Overview: The Request for Authorization for Medical Treatment (DWC Form RFA) is required for the employee's treating physician to initiate the utilization review process required by Labor Code section 4610.

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What is an RFA form?

What is a RFA report?

The problem that attorneys and injured workers face is that the evidence needed to determine whether the UR report is on time relies on a document that is difficult to obtain. The rule works this way; the treating doctor requests treatment by using a required form, the Request for Authorization (RFA).

What does request for Authorization mean?

(t) "Request for authorization" 1 defines Request for Authorization as a written request for a specific course of proposed medical treatment. An RFA must meet both of the following criteria: Only for medical treatment and. Must be written.

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