How should claims adjusters respond when approving requests for authorization?
A. Claims adjusters are allowed to approve authorization requests. The approval must state the specific medical treatment service approved. (8 CCR § 9792.9(i)) For prospective and concurrent reviews, approvals require communication to the requesting provider only. The initial communication must be within 24 hours of the decision, by telephone call or fax. If this is done by phone, a written communication must also be sent within 24 hours for concurrent reviews and two business days for prospective reviews. If a decision is sent initially by fax, the full communication responsibility for the approval is met. (8 CCR § 9792.9(b)(3)) When the review is retrospective, approval must be communicated to the physician, the injured worker and his or her attorney (if applicable) within 30 days of receiving the medical information reasonably necessary to make the determination.
A. Claims adjusters are allowed to approve authorization requests. The approval must state the specific medical treatment service requested, and then approved. (CCR, Title 8 9792.9(i).) For prospective and concurrent reviews, approvals require communication to the requesting provider only. The initial communication must be within 24 hours of the decision, by telephone call or fax. If this is done by phone, a written communication must also be sent within 24 hours for concurrent reviews and two business days for prospective reviews. If a decision is sent initially by fax, the full communication responsibility for the approval is met. (CCR, Title 8 9792.9(b)(3).) When the review is retrospective, approval must be communicated to the physician, the injured worker and his or her attorney (if applicable) within 30 days of receiving the medical information reasonably necessary to make the determination.
