RFA walkthroughs
Find RFAs by status and age
Start with the overview, narrow the list, and open the treatment that needs attention.
Before you start
- Open Requests for authorization in your workspace. The RFA feature must be enabled for your organization.
- You need permission to read RFAs. Counts and available actions depend on your workspace.
- Aging counts calendar days since submission. Decision due uses the review clock after receipt of the complete request; these are separate dates.
- Standard prospective/concurrent review generally allows 5 business days; qualifying expedited review allows 72 elapsed hours; retrospective review allows 30 calendar days. Special review rules, incomplete requests, and documented extensions can change the deadline.
- For standard electronic submissions, after-hours transmission can move effective receipt to the next business day; expedited and concurrent requests have exceptions. For ordinary mail without receipt evidence, the receipt presumption generally starts five business days after documented mailing. A certified return receipt supplies the actual receipt date. Do not substitute the submission date for receipt evidence.
Numbered red outlines identify the controls used in each step. Select any screenshot to enlarge it.
1Start with the overview
Select Overview. The dashboard groups requests into Needs attention (1), Awaiting decision (2), and Finished (3).
Incomplete and Failed requests need attention. Sent and Received requests await decisions. Closed and Canceled requests appear under Finished. Aging shows calendar days since submission, not the utilization review deadline.
2Choose a status and age range
Select a count in an aging column. Here, select Received requests aged 15–30 days (1).
The RFAs list opens with both the selected status and age range applied.
3Open a matching request
Check the Status filter (1) and age range above the table, then select Review request (2).
The detail page opens for the selected RFA. You can review its treatments, documents, history, and available actions.
4Search as you type
Enter a patient, physician, claim, RFA, service, or code in Search requests (1). Pause briefly to see results. Clear filters (2) removes the search, status, and aging selection.
The search updates after a short pause without a Search button. The dashboard also refreshes automatically while open and when you return to it.
5Switch to individual treatments
Select Requested treatments (1). Select a treatment’s request link (2) to open its RFA at that treatment. Check Decision due (3) separately from submission age.
The treatment table retains the current search and filters and shows service, diagnosis, decision, and any recorded deadline. Pagination moves between requests, which can each contain multiple treatments. Day-based deadlines display in Pacific time; expedited deadlines include the time. Awaiting receipt means receipt evidence is missing. Not calculated means no usable deadline was returned; review the request’s timeline and deadline basis.
What these screenshots verify
Read the verification record for capture details and checks. Your application may use different colors, permissions, or enabled features.