Q: WHAT IS THE TIMELINE FOR A CLAIMS ADJUSTER TO APPROVE MEDICAL SERVICES ON A WORKERS COMP CLAIM?
SOME HAVE SAID THEY HAVE TO APPROVE SERVICES WITHIN 72 HOURS, THIS IS FOR DURABLE MEDICAL EQUIPMENT (DME)
A: The approval is authorized by the utilization review company that the Carrier subcontracts with. For Emergency there is no time line. For some emergencies it will be 72 hrs. For general denials it will be 3 or 7 days to respond to the request. Some DME less than $500.00 I believe doesn't require preauthorization. Likewise, some medical services do not require preauthorization. It really gets somewhat complicated.
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