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(a) “Authorization”

Regulation 9792.6.1, which is a list of definitions for Utilization Review, defines authorization as “assurance that appropriate reimbursement will be made for an approved specific course of proposed medical treatment...”

(c) "Concurrent Review"

Treating physicians are required to submit a complete and compliant Request for Authorization (RFA) for treatment.

(d) "Course of treatment"

Per regulation 9792.9.1(a), a request for authorization for a course of treatment must be in written form on the DWC Form RFA.

(g) “Dispute liability”

Under specific circumstances, a claims administrator may dispute liability for the medical treatment requested in a Request for Authorization (RFA).

(j) “Expedited review”

For both concurrent and prospective Requests for Authorization (RFAs), a treating physician can request that a claims administrator expedite the utilization review of the requested medical services.

(s) "Prospective Review"

Treating physicians are required to submit a complete and compliant Request for Authorization (RFA) for treatment.

(t) "Request for authorization"

Treating physicians are required to submit a complete and compliant Request for Authorization (RFA) for treatment.

(u) "Retrospective Review"

Treating physicians are required to submit a complete and compliant Request for Authorization (RFA) for treatment.

(w) “Utilization review decision”

A utilization review decision approves, modifies, delays, or denies the RFA recommended treatment.

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