The Top Tier program is for attending providers who demonstrate occupational health best practices. This program is in final development stages. Initially, we will invite providers who qualify based on a subset of the program criteria.
- Be an attending provider (AP) within L&I’s Medical Provider Network on at least 12 allowed state-fund claims in the past year.
- Complete program application and pass test.
- Consistently meet or exceed targets in program best practices.
- Submit billing, utilization review, Report of Accident, Activity Prescription Form, and Provider Chart Note electronically.
- Pass qualitative claim review.
- Identify a health services coordinator within 90 days of program acceptance.
Top Tier best practices align with the Centers of Occupational Health and Education (COHE) program. Occupational health best practices were developed with the assistance of the University of Washington. Opioid best practices were adopted from the Bree Collaborative Prescribing guidelines.
Top Tier providers must:
- Submit a timely and complete Report of Accident (ROA) (F242-130-000) to ensure claims are opened quickly.
- Complete an Activity Prescription Form (APF) (F242-385-000) during the first office visit, or when patient restrictions change, so that the worker, employer, and claim manager understand the treatment plan and recovery expectations.
- Discuss return-to-work options with the employer when the worker has restrictions.
- Identify barriers to recovery and solutions to those barriers with each worker.
- Prescribe opioids appropriately.
Health services coordinators (HSCs) help providers, workers, and employers.
Their standard work includes (when needed):
- Coordination and tracking of referrals.
- Assessment of barriers to recovery.
- Referral to community services.
- Assistance with medication issues.
- Coordination of return to work.
- Support during transitions of care.
- Ongoing monitoring of recovery.
- Coordination of surgical care.
Each Top Tier provider must designate a health services coordinator. Top Tier health services coordinators must pass a test and apply for an L&I Provider ID.
Provider incentives are currently being finalized.
Frequently Asked Questions
Yes, the APF and ROA can be completed and submitted through My L&I on the provider dashboard. In addition, both are also available as a Health Information Exchange (HIE) transactions.