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Copyright 2015 RateFast Speed Seminar RFA’s and the Utilization Review Process

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RateFast Speed SeminarRFAs and the Utilization Review Process

Copyright 2015

Define:

An RFA is a standardized form which includes a diagnostic code of the treatment being requested. RFAs are created as a sister to a Doctors First, PR-2, or PR-4 report and sent to the the Utilization Review (UR) department.

UR Checklist:

Thoroughly complete RFAFull medical report attached with RFAPatients medical history

Problem Solving

Question: You are requesting authorization for a treatment that the patient has already used. What should your report include? Answer:Functional ImprovementCompliance with Current TreatmentsWorsening of Condition

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Copyright 2015

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