RFA walkthroughs
Review, sign, and prepare delivery
Review the signing form, confirm the administrator’s routing instructions, and inspect the packet before delivery.
Before you start
- Start with an RFA draft and supporting documents.
- The requesting physician must have a saved signature. Signing requires an authorized reviewer and the appropriate permission.
- Confirm the claims administrator and the authorization destination for this specific claim.
Numbered red outlines identify the controls used in each step. Select any screenshot to enlarge it.
1Review the exact form and sign
Choose Prepare signing preview, then open Open DWC-RFA signing preview PDF or Download PDF. An authorized person must review that exact form before checking the authorization statement and choosing Sign reviewed request. This uses the requesting physician's saved signature; the physician must have a signature available, and the user must have the relevant permission. If the request changes, prepare and review a fresh preview as required.
The exact signing preview is visible, and the signature action requires the review statement. This demonstration PDF tests the viewer; it is not a valid DWC form.
2Confirm the claims administrator's destination
In Review packet and send, choose a delivery method and review Authorization destination. Select the applicable Authorization contact explicitly. A central fax is appropriate only when the administrator's instructions say it applies to this claim. Some administrators route by a claim-handling office or require an adjuster's individual destination. Add an optional fax cover-sheet message if needed.
The selected authorization contact determines the destination used for the packet preview. Confirm it applies to this claim before proceeding.
3Enter a named adjuster's fax when required
When the routing instructions require an individual adjuster, obtain the destination from the handling adjuster. Choose Enter the handling adjuster's fax, then supply both Handling adjuster name (required) and Authorization fax number. A fax number alone does not satisfy this route. This screenshot is the same destination component shown independently with a synthetic administrator that requires adjuster-specific routing.
The component requires both a named handling adjuster and a fax number. Entering only a fax number is insufficient for this route.
4Review the complete packet
Choose Prepare packet with cover sheet and open Open RFA submission packet PDF. Review the assembled form, cover sheet, and supporting documents, then check the packet-review statement. If the destination, message, or documents change, review the newly prepared packet. The captured environment shows the sandbox notice: external fax and email delivery are disabled. Live sending was deliberately not exercised in this audit.
The packet viewer and review statement appear. The example displays a sandbox notice and disables external delivery; no live send was tested.
5Download for manual submission
Choose Download for manual submission when you will deliver the packet outside the application. Downloading preserves a packet for that workflow; it does not establish that the recipient received it or mark the request as sent. Keep evidence of any subsequent delivery.
The PDF is available to download. The request remains unsent: a download is not delivery evidence.
What these screenshots verify
Read the verification record for capture details and checks. Your application may use different colors, permissions, or enabled features.