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Dental Services

Authorization is required for all dental care.

How do I get authorization?

L&I (State fund):
Complete one of the following and fax it to 360-902-4567.

  1. The American Dental Association (ADA) Claim form. Make sure you select “Request for Predetermination/ Preauthorization” in section 1.
    or
  2. The L&I preauthorization form.
    Note: Completing either of these forms creates a high priority work item for the claim manager. These forms have proven highly effective in expediting authorizations.

Self-insured:
Contact the Self-Insured Employer
 

Why you should become a network provider

Dental providers practicing in Washington must join L&I’s Medical Provider Network in order to treat injured workers beyond the initial visit.

  • We will pay non-network dentists for treatment performed only on the patient’s initial visit. The initial visit is when the provider is assisting the injured workers in completing the Report of Accident (ROA) or Provider’s Initial Report (PIR). 
  • Most dental treatments would not qualify as an initial visit. 
  • To provide ongoing treatment and get paid for it, you must be an L&I network provider.
  • Become an L&I provider (both network and non-network). 

Coverage and treatment information

The treatment plan and/or alternative treatment plan must be completed and submitted before authorization can be granted. 

Billing and payment policies

Related rules

WAC 296-20-01010 Scope of health care provider network.
WAC 296-20-110 Dental.
WAC 296-23-160  General information and instructions.
WAC 296-20-06101 What reports are providers required to submit.

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