Happy Monday team!
By special request, this week’s tip covers the wonderful and exciting world of the Board form WC-205 (insert sarcasm) and how to properly respond!
JOHN’S GA TIP OF THE WEEK: How to Respond to a WC-205: Request for Authorization of Treatment or Testing by Authorized Medical Provider
WHAT IS THE WC-205?
- Under Board Rule 205(b)(3), an authorized treating physician “may request advanced authorization for treating or testing” by completing sections 1 and 2 of the Board form WC-205 and faxing or emailing to the insurer/self-insurer with supporting medical documentation.
HOW TO RESPOND
- The insurer/self-insurer must respond by completing section 3 of the WC-205 within 5 business days.
- The response must be via fax or email to the requesting authorized medical provider.
BEWARE!!
- If the insurer/self-insurer fails to respond to the WC-205 request within the five-business day period, then within 21 days of the initial receipt of the WC-205, the insurer/self-insurer must either:
- Authorize the requested treatment or testing in writing, OR
- File a WC-3 controverting the treatment or testing and list the specific grounds for the denial (box #2 on the WC-3).
- If the Employer fails to comply with Board Rule 205(b)(3), the employer “shall pay for the treatment test/requested related to the compensable injury.”
I hope everyone has a great 4th of July weekend! As always, feel free to give me a call/text/email if you run into any GA questions or issues.
Sincerely,
John Fennelly | Junior Partner