Does sending the requesting physician an approval of a request for authorization mean that payment must be made for the authorized service?
A. Yes. Authorization means “assurance that appropriate reimbursement” for the treatment specified will be paid. (CCR, Title 8 9792.6(b).) Effective Jan. 1, 2010, Labor Code 4610.3 was added and provides, in pertinent part, that once an employer (or its insurer or URO) ‘authorizes’ medical treatment, that authorization shall not be rescinded or modified for any reason after the medical treatment has been provided based on the authorization, even if the employer later determines the physician ‘was not eligible to treat’ (e.g. was not an MPN provider). Under the UR regulations, treatment is ‘authorized’ when the decision to approve the RFA is communicated to the requesting physician. The section also states that if the ‘authorized’ treatment was for a series of treatments or services (e.g. physical therapy; prescription refills), the employer may rescind or modify the authorization only for those treatments or services in the series not already provided. Under some circumstances, an empl
Related Questions
- How does GED Testing Service envision accommodations functioning in CBT (both the request and approval processes, and the provision and recording processes)?
- I need to request a prior authorization for a physician in a group practice. Do I use the groups NPI or the physicians NPI when requesting the PA?
- Who is authorized to sign an encumbrance authorization request?
