Preguntas frecuentes

Why do psychologists need to join the MPN?

All providers who can serve as attending providers are required to be credentialed into the L&I Medical Provider Network. The credentialing process ensures high quality providers are delivering care to workers.

What is an attending provider?

An attending provider is the primary coordinator of the care and treatment for the workers industrial injury or occupational disease. They coordinate referrals for additional care, and certify the need for additional benefits such as wage replacement. Workers have the right to choose as well as change their attending provider.

Where can I find information about billing and payment?

The L&I payment policy is found at: Medical Aid Rules & Fee Schedules (MARFS)
Chapter 2 - Information for All Providers
Chapter 17 - Mental Health Services

The fee schedule is updated annually and effective July 1 of each year.

What happens if treatment is rendered after June 30, 2025, and I have not yet enrolled in the MPN?

Payment for treatment beyond an initial visit cannot be issued if you have not applied to be part of the MPN after June 30, 2025. If a psychologist does not join the MPN, effective July 1, 2025, they will only be allowed to provide the initial visit only on cases solely for mental health (where no physical condition is or has been present) until their application is received and processed.

Can I still become an AP after June 30, 2025?

You can still join the MPN to treat workers and be an AP after June 30, 2025. Applications to the MPN July 1, 2025, and beyond will need to be started through ProviderOne.

Can I still treat workers if I am not part of the MPN?

No. You may not treat a worker. However, you can provide an initial visit on solely mental health claims which allows you to file the Report of Accident (ROA - for State Fund claims) or the Self-Insurance Accident Report (SIF-2). The worker must seek care from an MPN provider for treatment. If the worker needs treatment or ongoing care, they must transfer to an MPN psychologist.

How can I learn more about the billing process?

Billing information can be found on the public website at Billing L&I.
General billing workshops are taught monthly. Register to attend at: Billing Workshops.

Are referrals and authorizations still required for mental health consultations and care?

Referrals and authorizations are not required for the initial visit. Treatment after the initial visit requires 90-day pre-authorizations. This means that every 90 days the mental health provider must substantiate the need for continued treatment and request authorization.

What is the definition of an Initial Visit?

WAC 296-20-01002 defines “initial visit” in Washington workers’ compensation as:
“The first visit to a health care provider during which the Report of Industrial Injury or Occupational Disease (ROA) is completed and the worker files a claim for workers’ compensation.”

The associated code for ROA/PIR is 1040M. Providers should also bill the code that most accurately represents the service performed (typically 90791 for evaluation). There is only one initial visit per claim.

When a worker already has an established claim with an attending provider and is seeing a psychologist for the first time, the psychologist will not bill for an initial visit or fill out an ROA. However, a mental health evaluation is required before initiating treatment. Prior authorization would be required for this type of visit. The psychologist should bill the code most accurately reflecting the service performed (typically 90791 for evaluation). Psychologists may perform initial visits on solely mental health claims without prior authorization. All other mental health services require prior-authorization.

When a claim has already been established by filing an ROA, and a mental health diagnosis is suspected by the current attending provider, does the psychologist need prior authorization for evaluating the worker?

Yes, a prior authorization must be obtained for all mental health visits unless it is the initial visit to establish a solely mental health claim.

Do I have to be the attending provider on the claim to treat a worker?

No. Serving as the attending provider is optional. However, all psychologists must join the MPN to provide treatment beyond the initial visit.

Can I be the worker’s attending provider if there were previously physical conditions authorized to receive care under the claim but those are now resolved?

No. Psychologists can only be the attending provider on claims solely with mental health conditions – no physical condition(s) allowed at any point during the life of the claim.

Why do I need to provide all documentation of treatment to the insurer?

Industrial insurance is a medical-legal system funded by premiums paid by employers and workers. Workers’ compensation benefits are awarded and paid by the insurer according to the laws of Washington State. Documentation from providers proves the legal need for continued benefits including medical care and wage replacement. All providers, regardless of service rendered, are required to document all services and only render services related to the claim that are billable under the claim. Documentation is required across provider types for every billed service.