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Orthopedic and Neurological Surgeon Quality Project

Billing

Ortho-Neuro Surgeons participating in this project bill using the following codes and limits for services provided:

Code Service Description Maximum fee Comments
1071M

Quality Indicator Incentive Pay
in conjunction with completion of Activity Prescription Form (APF)

Quality Indicator Incentive Payment.

Billed and payable when an APF is also paid for the same date of service.

Payment level based on assigned tier for each provider:

Fees effective July 1, 2017:

Tier 3: $111.15
Tier 2: $83.35
Tier 1: $55.57

Payable to all Ortho-Neuro Project Surgeons.

Payable only when the APF is also paid to the same provider for the same date of service.

Not Payable to PA-C or ARNP.

Payable during global surgery period.

1073M Activity Prescription Form (APF) completion

Billed and payable when an APF is completed during an office visit and signed by the provider.

New billing limits.  The limits per provider per worker will be:

  1. 6 APFs within the first 60 calendar days of the initial visit date, and
  2. 4 APFs within each 60 calendar days thereafter.

 

Fees effective July 1, 2017:
$52.88

 

Provider generated.

Payable to all Ortho-Neuro Project Surgeons, even those who lose incentive pay after failing to meet Tier 1 requirements for 2 consecutive measurement cycles.

Payable at 90% of maximum allowable fee to PA-C and ARNP providers that sign supplemental application.

Payment may be tied to completeness.

Also covered for Center of Occupational Health and Education (COHE) providers.

 

 

Note: 1069M was payable at a maximum fee of $50.82 from July 1, 2014 and was end dated December 31, 2014. Effective January 1, 2015 the code was changed to 1073M.

Bill promptly for project services

Billing promptly will ensure that we have received all the information we need to assign you to the appropriate payment tier.

Know the bill payment cutoff dates

Bills are processed every other Friday. See cutoff and payment dates.

Payments are mailed during the week of the payment date (beginning on Tuesday).

Resources

  • 800-848-0811 - Provider Hotline, for all billing questions and to request L&I published forms and manuals.
  • 800-831-5227 - To get claim or bill status information through an automated phone line.
  • 360-902-6511 - Electronic Billing Unit, to get billing information on State Fund claims.

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