As part of recently passed legislation, SB 1160, the Division of Workers’ Compensation (DWC) will be collecting data on all Requests for Authorizations (RFAs) from carriers/self-insured employers statewide.
What do they plan to do with this mountain of data?
Look for trends.
· Utilization Review companies gaming the system and inappropriately denying or modifying care.
· Payors/Self-Insured Employers who do not respond in a timely manner to a request for medical treatment.
· Providers who are not following evidence-based DWC MTUS guidelines.
COA wants to have data from our members as well.
❶ BAD UR.org
Tell us about . . .
· Bad UR decisions
· UR decisions made by inappropriate physician specialties
· Inefficient UR systems that unnecessarily delay care
· Who is the worst UR physician that you routinely deal with?
· Who is the worst claims adjuster?
· Which payor/self-insured employer has the most inefficient UR system?
❷ Good Utilization Review Physicians
We also want to identify the names of physicians who do a good job as a Utilization Reviewer often with very limited information.
Complete the COA Feedback Form to provide your input.
Bad UR Feedback Form Good UR Feedback Form
COA will summarize the results of the feedback and provide the information to DWC. Your name will be kept confidential.
Here’s your chance to change the UR process.
Send in your data today.
