The Product Demo

RFA — requesting more sessions

Chapter 11 · 45 sec
The RFA — structured request, MTUS-cited rationale, and the §4610 clock

Sofia's care plan was for 12 sessions. She's responded well but needs another 4 to complete the CPT trauma-focused protocol. The psychologist drafts a Request for Authorization. CareHub queued it on the RFA review surface.

Top of the surface — patient header, status pill says Awaiting your signature or With UR depending on where it is in the cycle. Below, the 5-day service clock — CA Lab Code §4610 says the RFA has to be served on the adjuster within 5 days of the visit that produced it. Right next to the clock, the payer card — the adjuster who will receive it.

The Request section shows the structured ask: extension, CPT 90834, weekly times 4 sessions, dates of service, F43.10 PTSD as primary diagnosis. The clinical rationale below — drafted by CareHub Intelligence from Sofia's measure data, session notes, and the care plan — cites MTUS §9792.24.2 directly and references the reliable-change deltas on PHQ-9 and GAD-7.

The approval prediction shows a strong likelihood, based on rationale completeness, MTUS citations, and the carrier's historical approval pattern for trauma-focused CBT extensions. She clicks Sign and serve. The RFA is served on the adjuster. The CCR §9792.9 five-business-day UR clock starts. The system tracks it.