Claim Manager Authorizations

To contact the claim manager

To find out what services must be authorized by the claims manager, check out our fee lookup utility. Below are common services authorized by the claims manager.

  • Consultations, such as;
    • Psychiatric,
    • Pain Clinics.
  • Referrals to mental health specialists.
  • Chiropractic visits with physicians who use E/M office visit codes.
    • Office calls in excess of the first 20 visits or 60 days (whichever occurs first).
  • Most inpatient hospital admissions.
  • Outpatient surgeries/procedure:
    • All treatments require claim manager authorization.
  • Home nursing, attendant services or convalescent center care must be authorized per provisions outlined in WAC 296-20-091.
  • Diagnostic or therapeutic injection. Epidural or caudal injection of substances other than anesthetic or contrast solution will be authorized under the following conditions only:
    • When the worker has experienced acute low back pain or acute exacerbation of chronic low back pain of no more than six months duration.
    • The worker will receive no more than three injections in an initial 30-day period, followed by a 30-day evaluation period. If significant pain relief is demonstrated one additional series of three injections will be authorized. No more than six injections will be authorized per acute episode.
    • See L&I's Drug Policy page for more information.

Don't know who is the claims manager is?

  • You can call the Interactive Voice Response Message System (800-831-5227) to obtain the name and phone number of the claim manager on a particular claim.

Helpful Hints to Expedite Claim Manager Authorization

Be sure to identify the procedure code(s), dates of service, diagnosis, prescribing provider and your contact information when requesting authorization.

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