December 2011

Provider News

This is a monthly roundup of L&I news for medical providers. To subscribe by email, join our Medical Provider News email list.

In the Provider News for December 2011:


Getting ready for L&I's new statewide medical network in 2013

Beginning January 1, 2013, workers needing treatment for a work-related injury or illness will choose a provider for ongoing care from a new statewide provider network. L&I will manage the new network and plans for it to be large and inclusive.

In 2012, L&I will begin contacting providers to invite them to apply and will be enrolling qualified providers throughout the year. Some providers may be enrolled by their clinics or other organizations.

The first phase of enrollment will apply to the following provider types: physicians, chiropractors, naturopathic physicians, doctors of podiatry, advanced registered nurse practitioners, physician assistants, dentists, and optometrists. More detailed information about the network is available at www.ProviderNetwork.Lni.wa.gov.


Draft network standards are available for public comment until Dec. 16

The proposed rules will set credentialing standards for L&I providers, the first step in creating the statewide medical network that will launch January 2013. The standards will apply to providers who treat injured workers covered by the state workers' compensation program as well as those covered by self-insured employers. For more, read L&I's November 9 news release.


Expanding the Centers of Occupational Health and Education

COHEs are health-care delivery organizations, such as clinics or hospitals, that help providers coordinate care and use occupational-health best practices to treat injured workers. Research has shown that COHEs help injured workers return to work sooner and reduce claim costs. Currently, the state's 4 COHEs treat about one-fourth of all State Fund workers' compensation claims.

L&I will extend COHE access to at least 50% of injured workers by December 2013 and to all injured workers by December 2015. L&I recently began piloting new standards, performance measures, and financing methods with the four existing COHEs to develop a consistent, sustainable model to be used in all future COHEs.

If you want to understand more about the COHE program, and might be interested in supporting one in your community, check out the COHE website.


A new Stay at Work program, but no new provider paperwork

Washington employers soon will be able to apply for wage and expense reimbursements if they've kept an injured worker in a light-duty or transitional job. L&I will not ask health care providers to make any change in their routine for reporting work restrictions and light-duty job descriptions. However, we expect the new financial incentive to increase the number of requests that employers send providers for these medical approvals. Billing codes for this service will remain the same.


Getting an electronic adjustment on your previously processed bill

We now offer electronic adjustments on your previously processed bills. You can also mail us a request for an adjustment. Here's how and when to submit an adjustment, or to re-bill:

Should I request an adjustment or re-bill?
Should I request an adjustment or re-bill?
If: Then you should:
You made a mistake when you billed L&I and it caused an underpayment or overpayment.
Request an adjustment.
We paid an entire bill in error and you want us to reverse the charge.
The entire bill has been denied. Re-bill us.
How should I request an adjustment?
How should I request an adjustment?
If you submitted your bill by way of: Then you should:
Clearinghouse or your own software Submit an adjustment transaction through your clearinghouse or software program. For help, contact your clearinghouse or software vendor.
Direct Entry Follow the instructions in the guide Adjust, Submit, or Void a Direct Entry (1.75MB PDF).
Paper Complete a Provider's Request for Adjustment form (F245-183-000).

More information about billing electronically is available on our Provider Express Billing (PEB) page.


Late ROAs will reduce your fee beginning in 2012 (State Fund)

In a new payment policy effective January 1, 2012, if your office files a the Report of Industrial Injury or Occupational Disease (also known as an ROA) more than 5 business days after an injured worker's first treatment date, you will be paid less than if you get the form to us right away. We will pay for the ROA on a graduated scale based on when we receive it.

When injuries are reported quickly, worker outcomes improve. By submitting accident reports promptly, you will help us deliver services at the right time to injured workers and their employers. 


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