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Workers' Comp Unwrapped 222: When to Involve Utilization Review in Workers’ Comp Cases
Manage episode 482288037 series 3610420
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Workers Comp Unwrapped – Episode 222
Topic: When to Involve Utilization Review in Workers’ Comp Cases
Subtitle: How to Survive UR, Get Approvals, and Actually Get Paid
Host: Max
Guest: Ayesha
Description:
Utilization Review (UR): the gatekeeper of treatment approvals and the bane of every provider's existence. In this episode, Max and guest Ayesha dive deep into the what, when, and how of UR in California workers’ comp cases. From understanding Labor Code § 4610 to decoding why your RFAs keep getting denied, this episode unpacks the rules, timelines, and strategies that separate denied claims from paid ones.
You’ll learn:
- What UR actually is and why it exists
- When you must submit an RFA—and how to do it right
- Common reasons RFAs get denied (and how to fix them)
- What happens after a denial—and when IMR can save the day
- How teams like MLM boost approval rates with smart submission strategies
Whether you're a physician, biller, or just tired of the phrase “we didn’t get your RFA,” this episode is packed with practical insights and compliance-critical tips.
Key Takeaways:
- UR delays = payment denials
- Incomplete RFAs = fast rejections
- Missed timelines = lost revenue
- Strategy = survival
Bonus: Ayesha answers real UR survival questions from the field, including how MLM ensures your RFAs don’t just get sent—they get approved.
Tune in, take notes, and take control of your UR process.
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