Add / Send RFA

DaisyBill makes creating and submitting Requests for Authorization (RFAs) a snap. To get started, follow these steps.

Step 1. From the Injury Page, click ‘Add’ under ‘RFAs’

The number in parentheses next to View indicates the number of RFAs created for the Injury.

Alternatively, click View to review the created RFAs. Then from Requests For Authorization, click Add RFA.

Step 2. If there’s no RFA Claims Administrator Information you’ll have the option to add it. 

An RFA requires RFA Claims Administrator Information before being sent.  This information populates the following fields under the ‘Claims Administrator’ heading on the DWC Form RFA: Contact Name, Fax Number, Telephone, Email.

Once RFA Claims Administrator Information is entered, this step will be skipped.

Step 3. Select ‘New Request’ or ‘Resubmission – Change in Material Facts’

Select New Request for treatment that has not been previously requested.  For treatment being requested again after a denial or modification, select Resubmission - Change in Material Facts.

For more information, click the DWC Form RFA Instructions link.

Step 4. Select ‘Requesting Physician’

Start typing to select an existing Requesting Physician or to create a new one. This required field populates the following fields on the DWC Form RFA under the heading ‘Requesting Physician Information’: Name, Specialty, and NPI Number.

You can add / edit / deactivate Requesting Physicians in your DaisyAuth Settings.

Step 5. Select ‘Practice Location’

Start typing to select an existing Practice Location or to create a new one. This field populates the following fields on the DWC Form RFA under the heading ‘Requesting Physician Information’: Practice Name, Address, City, State, Zip Code, Phone Number, and Fax Number.

You can add / edit / deactivate Practice Locations in your DaisyAuth Settings.

Step 6. Select ‘Practice Contact’

Start typing to select an existing Practice Contact or to create a new one.  This field populates the following fields on the DWC Form RFA under the heading ‘Requesting Physician Information’: Contact Name, and Email.

You can add / edit / deactivate Practice Contacts in your DaisyAuth Settings.

Step 7. Review or Add ‘Claims Administrator Information’

The fax number entered here will determine where your RFA is sent.  Populates ‘Claims Administrator’ section on the DWC Form RFA: Contact Name, Fax Number, Address, Telephone, Email.

Step 8. Optional: Select an ‘RFA Template’

Start typing to select an existing RFA Template or to create a new one.

You can add / edit / deactivate RFA Templates in your DaisyAuth Settings.

Step 9. Enter ‘Requested Treatment’

  • ICD-10: ICD-10 codes for the patient substantiating the Services/Good Requested
  • Diagnosis: automatically populates based on the ICD-10 entered
  • Service/Good Requested: the name of the treatment, procedure, product, device, etc. requiring authorization.
  • CPT/HCPCS: optional field for the CPT/HCPC of the Services/Good Requested
  • Other Information: optional field for additional information such as frequency and duration.
  • To add an additional Requested Treatment click “Add Requested Treatment”

        

Step 10. Select ‘Request Type’

Select appropriate Request Type. This information does not populate the RFA form, but is used to calculate the RFA Due Date.

  • Concurrent requests are submitted during inpatient medical treatment. For a concurrent request, the RFA decision is due within five business days from the date of receipt.
  • Prospective requests are submitted prior to medical treatment. For a prospective request, the RFA decision is due within five business days from the date of receipt.
  • Retrospective requests are submitted after medical treatment. For a retrospective request, the RFA decision is due within 30 business days of the date of receipt.

Step 11. Enter ‘Requested Treatment Summary’

The Requested Treatment Summary uses the first 50 characters of the service/good requested to automatically summarize the RFA. This does NOT go out on the RFA, and is for internal use only. Step 12. Click ‘Save Changes’

Step 13. To add Supporting Documents, click the ‘Add Document’, then upload documents

Supporting Documents are required. Multiple documents can be attached to the RFA. Click Add to upload Supporting Documents one of two ways: 

  • Drag and drop file(s) into the box
  • Click ‘Select Files’ and search for file(s) to upload

Step 14. Click ‘Send’

To preview the RFA before sending, click Preview RFA.

You’re all set!

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