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Medical Provider Network

 

Rules

Rules relating to the network have been proposed and adopted in 3 phases. The latest rules are listed first.

Adopted Rules

Aligning rules for self-insurers (effective May 10, 2013)

This rulemaking includes requirements that self-insurers make certain their workers receive the information necessary to access care within the health care provider network.

 

Emergency rule regarding enrollment process (effective March 1 - June 29, 2013)

An emergency rule went into effect March 1, 2013 and is in effect for 120 days. It allows any provider who applied to join the network before January 1 to continue to treat, as long as a final decision hasn't been made on their application and it hasn't been withdrawn.

Also, until the Emergency Rule expires, there is no 60-day limit on provisional status.

 

Phase 3: Amendments to network rules (effective Dec. 14, 2012)

This third rulemaking phase amends certain L&I rules that conflict with the legislation to implement the network.


Phase 2: Rules concerning injured workers' first visit (effective Apr. 6, 2012)

The second phase rules allow injured and ill workers to see a provider of their choice for the initial visit to start their claims.

These rules also define what services may be provided by a non-network provider and when care must be transferred to a network provider.


Phase 1: Network rules (effective Feb. 3, 2012)

The first phase of rules established minimum standards for credentials of health care providers and other requirements for network participation.

These rules also clarify what constitutes patterns of risk of physical or psychiatric harm or death that determines when we may remove a provider from the network.


Legislation creating the network

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