Pre-authorizations

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See which treatments that require pre-authorization by L&I or the self-insurer.

For pre-authorization or more information

Call the Provider Hotline at 1-800-848-0811, 8 a.m. to 5 p.m. weekdays. The Provider Hotline staff authorize:

• Radiology services and diagnostic testing
  • Such as arthrograms, myelograms, bone scans, CT scans, EMGs and NVCs.
• Consultations,
• Durable medical equipment,
• Hearing aid services,
• Massage therapy,
• Non-targeted surgeries,
• Orthotics,
• Outpatient procedures,
• Physical therapy and
• Prosthetics.

or

Call Qualis Health for utilization review at 1-800-541-2894. Requests for review of the inpatient procedures is listed in Provider Bulletin 06-06 (151 KB PDF).

or

Check online, find out if treatment has been authorized on a claim.

Pre-authorization requests

Requests for pre-authorization must include a statement of:

• Condition(s) diagnosed,
• ICD-9 CM codes; including their relationship to the industrial injury/exposure,
• An outline of the proposed treatment program including its length and components,
• Procedure codes,
• Expected prognosis, and an estimate of when treatment would be concluded and condition stable.

Did you know?

The Provider Hotline can also answer your questions about:

• Bill payment or denial,
• Provider bulletins and updates,
• The Medical Aid Rules and Fee Schedule and
• Applicable sections of the Washington Administrative Code (WAC) or Revised Code of Washington (RCW).

For more detail, see:
Washington Administrative Code (WAC) 296-20-03001.