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Requirements and Tools

All self-insurers must be able to verify that Washington providers treating their injured workers (beyond the initial visit) are network providers. Emergency department providers and providers outside Washington state are not required to join the network. Review the list of providers that must join the network.

Note: For a definition of the initial visit, see WAC 296‑20‑01002 (leg.wa.gov).



What you need to do

To meet the requirements of the Medical Provider Network, self-insured employers or their third-party administrators need to:

  • Establish internal procedures to get updated provider status:
  • Notify workers who are being treated by non-network providers, and provide resources for those workers to find a network provider.
  • Make sure not to pay non-network providers for treatment beyond the initial visit.

Tools to notify workers

A sample letter and an informational flyer are available to assist you in notifying workers about the requirement to get ongoing medical treatment from a provider in the network. You are not required to use these; you may create your own communications if you prefer.

The sample letter allows you to provide general information to the worker regarding the requirement to get ongoing treatment from a network provider. The flyer contains more detailed information for workers. The flyer can be sent with the letter; or it can also be sent alone.


Help workers find a provider in the network

FindADoc is the best tool to use when assisting workers in finding a network provider. You or the worker can search for medical providers in the network by name, specialty, or location. The FindADoc tool doesn't include providers in provisional network status. Consider using the Provider Network Status Report to see if a particular provider has provisional network status.

Once the worker has chosen a network provider, the Transfer of Care (F207‑114‑000) form can be used to formalize and document their decision.


No billing to workers

Use the No Billing to Workers Sample Letter (15 KB MS Word) to let medical providers who aren't in the network know they can't bill injured workers for medical services related to their claim.

If you have communicated with a medical provider who has decided not to join the network, but continues to provide ongoing medical services for a worker's industrial injury or occupational disease condition, you can file a complaint.


Complex claims

If a worker with a complex claim is having difficulty finding a network provider, a new billing code is available that may be useful in facilitating the transfer of care. Read more about the Complex Claim Coordination Code (500 KB PDF / 1 min).

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