RFA walkthroughs
Create an RFA with supporting documents
Choose a patient and injury, describe the requested treatments, and attach the supporting PDFs in one flow.
Before you start
- Enable Requests for authorization in your workspace.
- Have permission to create RFAs, a requesting physician, and the patient and injury details.
- Have the supporting clinical PDFs ready. Use fictional records while testing.
Numbered red outlines identify the controls used in each step. Select any screenshot to enlarge it.
1Select the patient, injury claim, and requesting physician
From the RFA dashboard, choose New authorization request. Search for a patient or claim, select the Saved patient claim, then choose a Saved rendering provider as the requesting physician. Use Continue to treatment to open the draft form. An RFA can be created without an existing bill.
The selected patient, injury claim, and physician carry into the draft. No existing bill is required.
2Add a patient and injury when needed
If your integration enables patient and claim creation, the new-patient option lets you enter the patient's identifying information and injury claim in the same flow. Review the injury date, claim number, employer, and claims administrator before continuing. This capture shows the available fields; the audit canceled this branch and used a saved synthetic patient and claim for the remaining steps.
Patient and claim fields appear together. Creating new records depends on the permissions and features enabled in your integration.
3Set the request and review options
Choose New request or a resubmission with a material change. A resubmission needs an explanation of the change. Use the written-confirmation option when documenting a prior oral request. Choose the applicable review type and priority, then enter the clinical rationale. These are separate choices: expedited priority does not replace the request or review type.
The form keeps request type, review timing, and priority separate. The example uses a new prospective request with standard priority.
4Check the practice and authorization contact
Review the requesting practice and claims-administrator authorization contact. Saved billing providers and service locations can fill these details when supplied by the integration. The request keeps these details for its form. The delivery destination is reviewed separately before sending, using the claims administrator's routing instructions. Replies use the organization's managed fax number.
The practice and authorization contact details are available for review before the request is saved.
5Add diagnoses and requested treatments
Enter the diagnosis code and description, then describe the requested service. Include the procedure code when known, along with applicable quantity, units, frequency, duration, and requested dates. Add requested service adds another treatment to the same RFA. Review every treatment before saving; later decisions are recorded for individual treatments.
Each requested service has its own diagnosis and treatment details. More than one service can belong to the same RFA.
6Attach supporting PDFs before saving
Add the supporting clinical PDFs in Supporting documents. You can choose multiple files or drop them into the upload area; each file can be up to 25 MB. Choose Save RFA draft to save the request and attach the selected documents. Saving a draft does not send it.
The saved draft includes the uploaded supporting PDF. Creating the draft does not send a fax or email.
What these screenshots verify
Read the verification record for capture details and checks. Your application may use different colors, permissions, or enabled features.