Provider Newsletter - May 2013

Provider News

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

You can also read previous Provider News editions.

In the Provider News for May 2013:

L&I's new opioid guideline how will you track improvements?

Image of Opioid Guidelines

If you haven’t started familiarizing yourself with L&I’s new Guideline for Prescribing Opioids to Treat Pain in Injured Workers, we encourage you to do so before July 1 implementation.

The new guideline provides valuable information that will help you improve treatment for pain. One of its most important features is a requirement that injured workers must show clinically meaningful improvement in function (CMIF) if L&I is to continue paying for opioids beyond the acute phase of injury.

What is a clinically meaningful improvement in function?
Measuring function in addition to pain level may be new to many providers and patients. Function in this context means the patient’s ability take part in rehabilitation and wellness activities, as well as to participate in usual social and occupational activities.

The new guideline defines CMIF as an improvement in function of at least 30% as compared to the start of treatment or in response to a dose change. A decrease in pain intensity in the absence of improved function does not constitute CMIF.

We recommend that providers document a baseline measurement of pain and function within the first two weeks of seeing the patient.  When prescribing opioids beyond the acute phase (about 6 weeks), and after increasing the dose, the patient must show improvement in function. For chronic opioid therapy, in addition to other requirements, improvement in function must be sustained.

You can choose your screening tool
You should use the same validated instruments at each visit to track pain and function.  L&I endorses the Two Item Graded Chronic Pain Scale. It’s a quick, 2-question tool with consistent scales for pain and function; that is, a "10" on the pain scale is the worst possible pain, and a “10” on the scale for pain interference with function indicates that pain limits function completely. This tool will make measurement easier and give you a clearer picture of how pain medicines are affecting your patients’ lives.

You can find the Two Item Graded Chronic Pain Scale and other free, easy-to-use and validated screening tools in the Agency Medical Directors’ Group’s Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain (2010 Update).

Contact L&I's pharmacy manager at

Ever treat foreign workers? Remember these 2 tips

Image of H-2A visa worker consulting with a medical provider

In 2013 we’re likely to see a continuing increase in agricultural employers’ use of the federal Department of Labor’s H-2A program to hire foreign workers on a temporary basis. If you might treat injured workers with H-2A visas, be sure you know these basics. 

How do I recognize patients working on an H-2A visa?
Spanish-speaking workers on H-2A visas may not know the official name of the visa program. Many of these workers typically refer to themselves as los contratados and they will know that their contract will end on a specific date. If so, you can assume that they are working here on an H-2A visa.

What do I need to do if my patient is on an H-2A visa?
Make sure the L&I Report of Accident is complete, including a mailing address and contact information in the country of origin.  It’s also important to:

  • Let workers know they can complete a Report of Accident by phone in many languages by calling L&I at 1-877-561-3453.
  • Remember that offers of light-duty positions for these workers must not extend past the expiration date for their visas.
  • Encourage workers to get treatment as often as needed before they return to their countries of origin.  If further treatment is needed, the worker should request a provider application packet from L&I to give to a foreign provider, or find an L&I provider at
  • Advise workers to stay in touch with you, L&I, and the employer for updates or to make any changes in their contact information.

Medical network rules now apply to self-insured employers

New rules require self-insurers to notify their workers about how to access care within L&I’s new Medical Provider Network. Self-insurers also must:

  • Use only providers approved for the network.
  • Pay only network providers for care beyond the initial visit.
  • Assist workers in transferring care to a network provider.

The changes to Washington Administrative Code section 296-15-330 make the rules for self-insurers consistent with State Fund rules regarding the Medical Provider Network.

The rule change was effective May 10, 2013.

Billing workshops start in July

Here’s our list of billing workshops for 2013. In a workshop you will learn the best practices for billing L&I. Your L&I representatives will answer your questions, demonstrate tools and show you how to use all the resources on the L&I website. 

Did you know that free CME credits are available now for billing workshops? You will receive your certificate at the end of the workshop.

Workshop Schedule: "The Basics of Best Billing Practices"
2013 Workshop Schedule: "The Basics of Best Billing Practices"
Location Date (all workshops are 9 a.m. – 1 p.m.)
Vancouver L&I July 11
Trent Plaza, DSHS Spokane July 23
Trent Plaza, DSHS Spokane July 24
Trent Plaza, DSHS Spokane July 25
Mt. Vernon L&I August 14
Mt. Vernon L&I August 15
Yakima L&I September 17
Kennewick L&I September 18
Kennewick L&I September 19
Tumwater L&I September 27
Tukwila L&I October 1
Tukwila L&I October 10
To register
Email the following information to

  1. Full name (if you are registering more than 1 person, include their full names as well)
  2. Email address (for each individual you are registering to attend)
  3. Location
  4. Date you want to attend

You will receive a confirmation back. Upon request, we can fax or mail you a sign-up form.

Need to know about authorization requirements or drug coverage?

These 2 tools are fast and easy to use.

Need an authorization?
Not sure whether pre-authorization is required for a treatment or procedure?  Use our Quick Fee Lookup tool, which will also tell you who at L&I can authorize your request.

Need to know if L&I covers a particular drug or has preferred alternatives?
Use our quick Drug Look-up tool.  Remember that general information about L&I coverage does not guarantee coverage on an individual claim.

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