RFA-1LC

The Board implemented the mandatory online eForm for the electronic Request for Further Action by Legal Counsel (Form RFA-1LC) on December 13, 2024. This eForm represents another milestone in the OnBoard modernization program, which is transforming the Board from a paper-based system into an efficient and transparent electronic system to expeditiously deliver quality services to stakeholders. The new RFA-1LC eForm has embedded workflow process improvements that have already enabled the Board to schedule requested hearings about 30% faster than just eight months ago.

The RFA-1LC eForm allows the Board to receive requests and route them accurately within seconds so they can receive an appropriate response, resolution, or hearing date. Prior to the new eForm, it took up to 10 days for the Board to scan the form into eCase, manually review the information, and route the request to appropriate personnel for action. Moreover, approximately 20% of these requests were returned for being incomplete, something that cannot happen with the new eForm. The Board expects to gain even more efficiencies as attorneys become more familiar with the eForm submission requirements and we continue to evaluate potential enhancements to the RFA-1LC eForm to further improve Board processing and response.

Actions outside of the eForm’s scope

The Board’s website contains information to help guide attorneys with the eForm submission process (see the RFA webpage and FAQs). Please note that an RFA-1LC eForm is not required on requests that already result in an automated Board action, such as Stipulations and Section 32 waiver agreements. If timely action has not been taken on these documents that are already in the case file, follow up by submitting an online Claims inquiry.

For issues that do not result in an automated Board action and the request reason is not on the RFA-1LC eForm, attorney correspondence may be submitted. For example, correspondence may be submitted to request a decision to memorialize findings not in dispute.  

When to use the eForm for PARs

The Board has noticed frequent incorrect RFA-1LC eForm submissions requesting review of prior authorization requests (PARs). Only certain PAR denials are eligible to be submitted for review via the RFA-1LC eForm, and these will be displayed for selection on the eForm.

Please note the following PAR denials for which the RFA-1LC eForm can be submitted:

• Denial for administrative or no jurisdiction reasons – all PAR types except Medication.
• Denial for IME scheduling related reasons – only MTG Variance, MTG Special Services, and Non-MTG Over $1,000 PARs.
• Partial grant for medical reasons – only MTG Variance, MTG Special Services, and Non-MTG Over $1,000 PARs.
• Denial for medical reasons – only MTG Variance and MTG Special Services PARs. Please note examiner action is automatically triggered on Non-MTG Over $1,000 PARs denied for medical reasons. An RFA-1LC eForm is not required to request review.
• Denial for Level 3/MDO response – only Medication, Durable Medical Equipment, MTG Variance, and MTG Special Services PARs.

Please note that health care providers can request a Level 3 Medical Director’s Office (MDO) review for specific PAR types through OnBoard: Limited Release. If an RFA-1LC eForm is filed before an MDO decision is issued, the denial will be resolved through Adjudication and an MDO decision will not be issued.