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Add / Submit 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 ‘RFAs’

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

Step 2. If there’s no Contact entered, select a Contact to add

An RFA requires either an RFA Contact or Adjustor Contact. This information populates the following fields under the ‘Claims Administrator’ heading on the DWC Form RFA: Contact Name, Fax Number, Telephone, Email.

Once an RFA Contact or Adjustor Contact is entered, this step will be skipped.

Step 3. From Requests for Authorization, click ‘Add RFA’

Step 4. Enter ‘Requested Treatment Summary’

This required field does not populate the RFA form; it is only for DaisyBill identification purposes. For help with this field, click the gray ‘?’ icon next to the field name.

Step 5. Select ‘Request Type’

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

  • 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.
  • 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.

Step 6. 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 7. If applicable, select ‘Expedited Review’

Expedited Review only applies when there is an imminent and serious threat to the patient’s health. An Expedited Review RFA is due back within 24 hours.

Step 8. If applicable, select ‘Written Confirmation’

Select Written Confirmation if the request is a written confirmation of a prior oral request.

Step 9. Select Requesting Physician details

This required field populates the following fields on the DWC Form RFA under the heading ‘Requesting Physician Information’: Name, Specialty, and NPI Number.

Step 10. Optional: Select ‘Address’

This optional 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.

  • Use the Address drop-down list to select a specific Place of Service.
  • If left blank, the RFA form will automatically populate the Billing Provider information.
  • For help with this field, click the gray ‘?’ icon next to the field name.

Step 11. Optional: Select ‘Contact’

This optional field populates the following fields on the DWC Form RFA under the heading ‘Requesting Physician Information’: Contact Name, and Email.

  • Use the Contact drop-down list to select a specific User Contact.  
  • If left blank, the RFA form will populate with the information of the creating user.

For help with this field, click the gray ‘?’ icon next to the field name.

Step 12. Select ‘Claims Administrator Information’

If both an RFA Contact and an Adjustor Contact are entered, select which contact’s information should populate the following fields, under the heading ‘Claims Administrator’ on the DWC Form RFA: Contact Name, Fax Number, Telephone, Email.

Step 13. Enter or review ‘Diagnosis Codes’

If patient has ICD-10 Diagnosis Codes saved on their Injury page this field automatically populates with the saved ICD-10 codes.

  • DaisyBill defaults to using the same Diagnosis and ICD-Code for each Service/Good Requested.
  • To enter specific Diagnoses Codes for each Service/Good Requested, uncheck the ‘Copy Diagnosis to Treatments’ checkbox and manually enter ICD-Code and Diagnosis fields.

For help with this field, click the gray ‘?’ icon next to the field name.

Step 14. Enter ‘Requested Treatment’

  • Diagnosis: the written description of the ICD-Code(s)
  • ICD-Codes: ICD-10 codes for the patient substantiating the Services/Good Requested
  • Services/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.

For help with these fields, hover over the field heading.

Step 15. Click ‘Create RFA’

Step 16. To add Supporting Documents, click the ‘Add’ button, then upload documents

Supporting documents are required. Multiple documents can be attached to 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 17. Click ‘Submit’

To preview the RFA before sending, click Preview RFA.

You’re all set!

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