Billing Self-Insured Employers

When you treat an injured worker insured by their employer rather than by the State Fund, submit bills directly to the employer or their claims representative.

To determine if an employer is self-insured

 

Self-insured employers must authorize treatment (www.leg.wa.gov) and pay bills according to the same Medical Aid Rules and Fee Schedules followed by L&I.

If you don't agree with a payment received from a self-insurer, you must follow WAC 296-20-125(9) (www.leg.wa.gov), and inquire about it within ninety days of payment to be considered.

You can now bill the self-insured employer interest on the balance due when payment isn't made within 60 days of receipt of a proper bill.

 

Need L&I's Self-Insurance Section's assistance? All disputes must be received in writing.

ICD-10 Codes: Self-Insured Employer (SIE) Requirements

The Department wonít require self-insured employers to develop or change existing automated payment systems; however, the department will require that self-insured employers process proper billings.

If an approved provider submits a complete billing to a self-insured employer for proper and necessary medical services with the ICD coding as described below, the self-insured employer should respond to the billing as follows:

 

Before October 1, 2015

After October 1, 2015

For billings submitted with ICD-9 codes

The SIE would be required to pay based on ICD-9 coding if the bill is otherwise payable

The SIE may pay or may return the billing to the provider for proper ICD-10 coding*

For billing submitted with ICD-10 codes

The SIE may pay or may return the billing to the provider for proper ICD-9 coding*

The SIE would be required to pay based on ICD-10 coding if the bill is otherwise payable

*The SIE must consistently apply whichever approach it takes.

Related information

Self-insurance laws and rules

WAC 296-15 (www.leg.wa.gov) - Worker's compensation self-insurance rules and regulations.

 

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