L&I contracted with Qualis Health to provide utilization review (UR) services for its Workers’ Compensation Program.

What requires Qualis Health Review?

To find out what services require utilization review by Qualis, check out our fee lookup utility. Below are common services authorized by Qualis.

• All inpatient services
• Physical and occupational therapy after the 24th visit  
• Work Conditioning  
• Selected outpatient services require utilization review
• Advanced imaging of the spine, upper extremity, lower extremity, and head/brain.

Qualis reviews your request based on L&I’s Medical Treatment Guidelines. If there is no guideline, Qualis Health will apply InterQual criteria.

Qualis reviews for medical necessity and then makes a recommendation to the Department Labor and Industries to determine whether the service is related to an accepted diagnosis.  The Department will contact the provider via phone/letter with a final determination.

To Contact Qualis Health

• Phone 800-541-2894 or 206-366-3360.
• L&I’s main webpage for Qualis

*Check our Fee Schedule Lookup to see if a specific billing code requires pre-authorization.