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Requesting Authorization For Treatment

The recent passage of SB 863 has resulted in significant changes to several existing laws and regulations. The changes in Utilization Review (UR) are focused on streamlining the process and avoiding delays in treatment for injured employees. State Fund supports these changes and by implementing these new laws and regulations, hopes to achieve a more efficient process for both injured employees and medical providers.

As a reminder, and pursuant to the California Code of Regulations (CCR), requests for authorization must comply with the following to be considered for review and processed in UR:

For dates of injury on or after January 1, 2013, and requests made on or after July 1, 2013 for all other dates of injury:

CCR 9792.6.1 (t) - “Request for authorization” means a written request for a specific course of proposed medical treatment. A request for authorization must be set forth on the “Request for Authorization for Medical Treatment” (DWC Form RFA), completed by a treating physician, as contained in California Code of Regulations, title 8, section 9785.5. “Completed,” for the purpose of this section and for purposes of investigations and penalties, means that information specific to the request has been provided by the requesting treating physician for all fields indicated on the DWC Form RFA. The form must be signed by the physician and may be mailed, faxed, or e-mailed.

CCR 9785 (g) - The DWC Form RFA must include, as an attachment, documentation substantiating the need for the requested treatment (i.e. DLSR 5021, PR-2, or narrative report per instruction on the form).

For requests made prior to July 1, 2013 regarding dates of injury prior to January 1, 2013:

CCR 9792.6 (o) - A written confirmation of an oral request for a specific course of proposed medical treatment pursuant to Labor Code section 4610(h) or a written request for a specific course of proposed medical treatment. An oral request for authorization must be followed by a written confirmation of the request within seventy-two (72) hours. Both the written confirmation of an oral request and the written request must be set forth on the:

  • Doctor's First Report of Occupational Injury or Illness, Form DLSR 5021, section 14006, or
  • Primary Treating Physician Progress Report, DWC Form PR-2, as contained in section 9785.2, or
  • In narrative form containing the same information required in the PR-2 form. If a narrative format is used, the document shall be clearly marked at the top that it is a request for authorization.

Additional information about the required forms and access to them is available on the Department of Workers’ Compensation Web site at http://www.dir.ca.gov/DWC/forms.html.

To request treatment authorization, please fax your request for authorization (RFA) to the dedicated UR fax number of the regional office handling the claim.

State Fund Regional Office

 Dedicated UR Fax #

 Bakersfield

(707) 646-6801

 Bay Area Claims Services – Pleasanton

(707) 646-6291

 Eureka

(707) 646-6593

 Fresno

(707) 646-6592

 Monterey Park

(707) 646-2649

 Inland Empire Claims Services

(707) 646-6020

 Longshore & Harbor (L&H)

(925) 523-5058

 Orange County Claims-Santa Ana location

(707) 646-2462

 Redding

(707) 646-6939

 Riverside State Contracts

(707) 646-0738

 Rohnert Park State Contracts

(707) 646-0584

 Sacramento State Contracts

(707) 646-0438

 Santa Ana State Contracts

(707) 646-0826

 Stockton

(707) 646-8125

 

 

 

 

 

 

 

 

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