The problem
Orthopedic practices treat a steady stream of work injuries, but workers’ compensation doesn’t run on health plan rules. Each state sets its own fee schedule, authorization process, treatment guidelines, reports and billing deadline: 95 days from the date of service in Texas, 120 days in New York and 12 months in California, as our workers’ comp billing guide shows.
Authorization adds its own clock. In California, treatment requests go on the DWC Form RFA with supporting records, and the MTUS is presumed correct on the extent and scope of treatment. Prospective utilization review decisions are due within 5 business days of a complete RFA, and if requested records don’t arrive within 14 days, the request is denied until they do.
How it works
Read the chart: Rette’s AI agents connect to athenahealth or eClinicalWorks and read operative and clinical notes directly. Using another EHR? Ask about your EHR.
Check treatment criteria: Rette checks documentation against ACOEM and California MTUS treatment criteria.
Build the request: Rette prepares jurisdiction-specific authorization requests, such as the California DWC Form RFA, with supporting evidence cited from the chart.
Track the clock: Rette tracks review windows and deadlines and flags late decisions. Workers’ comp work sits in the same prioritized queue as prior authorization, denials and appeals.
What you get
Documentation checked against ACOEM and California MTUS treatment criteria
Jurisdiction-specific authorization requests with supporting evidence cited from the chart
Review windows and deadlines tracked, with late decisions flagged
Workers’ comp in one prioritized queue with prior authorization, denials and appeals
No data migration and no new system for staff to learn
Built for orthopedics
Rette is built with orthopedic surgeon advisors. Workers’ comp adds its own orthopedic pressure points:
Authorization records: match approval numbers, dates, units and codes to the bill. In a June 2026 Texas fee dispute involving CARC 197, DWC ordered no additional payment because no authorization showing the approved dates and units was submitted.
Claim numbers: a wrong or missing claim number can return as CARC 16, so verify it with the adjuster at intake.
Accepted body parts: treating a body part the carrier hasn’t accepted can bring an extent-of-injury denial, such as CARC 219.
Coding edits: Texas applies Medicare’s NCCI procedure-to-procedure edits to non-network professional claims, while California and New York publish their own rules.
Frequently asked questions
Which states does Rette support for workers’ comp?
Rette checks documentation against ACOEM and California MTUS treatment criteria and prepares jurisdiction-specific authorization requests, such as California’s DWC Form RFA, with supporting evidence cited from the chart. Support for other states’ forms and guidelines, such as New York’s prior authorization requests or Texas preauthorization, is confirmed on a call.
What happens when a utilization review decision is late?
Rette tracks review windows and deadlines and flags late decisions so staff can follow up. Each state sets its own clock; in Texas, for example, carriers answer preauthorization requests within 3 working days. What a late decision means depends on state rules, so confirm next steps with the claims administrator and your compliance team.
Does Rette handle workers’ comp alongside our other payer work?
Yes. Workers’ compensation sits in the same prioritized work queue as prior authorization, denials and appeals, so staff work from one list. Rette reads the notes in the EHR your practice already uses, so there is no data migration and no new system for staff to learn.
Rette reads the operative note in the EHR you already use, suggests codes and checks claims against payer and NCCI rules before submission.