Medical Provider Network
Joining the network? Sign up at www.JoinTheNetwork.Lni.wa.gov.
In January 2013, we launched a statewide network for providers who treat injured workers. The network is part of legislation passed in 2011.
Injured workers employed by both State Fund and self-insured employers are served by the network. "State Fund" employers are those who pay premiums to L&I for their workers' compensation coverage.
Rules concerning the network
When we propose rules and requirements that will apply the network, we post them online and encourage public input.
Advisory Group
The Provider Network Advisory Group represents the health care community, business and labor to provide input on standards and policies for the provider network.
Rules
Rules relating to the network have been proposed and adopted in 3 phases. The latest rules are listed first.
Adopted Rules
Aligning rules for self-insurers (effective May 10, 2013)
This rulemaking includes requirements that self-insurers make certain their workers receive the information necessary to access care within the health care provider network.
Emergency rule regarding enrollment process (effective March 1 - June 29, 2013)
An emergency rule went into effect March 1, 2013 and is in effect for 120 days. It allows any provider who applied to join the network before January 1 to continue to treat, as long as a final decision hasn't been made on their application and it hasn't been withdrawn.
Also, until the Emergency Rule expires, there is no 60-day limit on provisional status.
Phase 3: Amendments to network rules (effective Dec. 14, 2012)
This third rulemaking phase amends certain L&I rules that conflict with the legislation to implement the network.
More information
-
Concise Explanatory Statement (PDF 146KB): A summary of the proposed rules, comments that we recieved about the rules, and L&I responses to those comments. - Adoption (Rule-Making Order CR-103) (PDF 98KB)
- Adopted Rule Language (PDF 33KB)
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Phase 2: Rules concerning injured workers' first visit (effective Apr. 6, 2012)
The second phase rules allow injured and ill workers to see a provider of their choice for the initial visit to start their claims.
These rules also define what services may be provided by a non-network provider and when care must be transferred to a network provider.
- More information
-
Concise Explanatory Statement (PDF 118KB): A summary of written and oral comments on
the draft rules, with L&I responses.
-
Adoption (Rule-Making Order CR-103) (PDF 173KB)
-
Adopted Rule Language (PDF 69KB)
-
Phase 1: Network rules (effective Feb. 3, 2012)
The first phase of rules established minimum standards for credentials of health care providers and other requirements for network participation.
These rules also clarify what constitutes patterns of risk of physical or psychiatric harm or death that determines when we may remove a provider from the network.
- More information
-
Concise Explanatory Statement (PDF 950KB): A lengthy summary of written and oral comments on
the draft rules, with L&I responses.
-
Adoption (Rule-Making Order CR-103) (PDF 316KB)
-
Adopted Rule Language (PDF 67KB)
-
Legislation creating the network
Medical Provider Network Q & A's
Read Q&A for injured workers instead.
Enrollment
When did the medical provider network begin?
January 1, 2013.
- Who should be in the provider network? For example, does it include all provider types, such as pain clinics, physical therapists, and audiologists?
The following provider types that practice in Washington State must be in the network in order to treat injured workers beyond the first visit:
- Physicians
- Chiropractors
- Naturopathic physicians
- Podiatric physicians & surgeons
- Dentists
- Optometrists
- Advanced registered nurse practitioners
- Physician assistants
If you are not listed above, or you practice out-of-state, you can continue to treat injured workers in 2013 without joining the network.
Beyond 2013, we will enroll other provider specialties in phases, so eventually all medical providers will be required to be in the network to treat injured workers. Requirements will differ for different provider types. - Is there a limit to the number of providers in the network?
No. It's an open network - we are accepting all qualified providers who meet network requirements.
- When will I hear back after I've submitted my application?
Unless we need additional information from you, we will mail you a letter confirming that we have received your completed application. We will write again after your application is approved or denied. If you don't hear from us within 120 days of the first letter, you may contact us about the status of your application by calling 360-902-5140.
- I applied to join the network a long time ago, yet the L&I website shows I have not applied. Why?
Applications in process are shown on the Medical Provider Network Status Lookup.
We have completed our review on most of the 15,000 applications we've received, but many applications are still being processed.
If you applied several weeks ago but the status lookup does not show that you have an application in process, please email ProvNet@Lni.wa.gov or call us at 360-902-5140.
- I applied to join the network, but the status lookup on your website says “Application incomplete.” What does this mean?
We were unable to process your application because it was missing information. Please email us at ProvNet@Lni.wa.gov or call 360-902-5140.
You can resubmit your application with the missing information at any time.
- NEW: I was contacted by Medversant about my application; what is their role?
L&I has contracted with Medversant to gather documents needed for applications and verifying credentials. If Medversant contacts you, please respond to them directly by:
- Calling 800-508-5799
- Faxing requested materials to 877-303-4078, or
- Emailing provider.support@medversant.com
Standards
- What are the standards for joining the network?
The standards for joining the network are described in administrative rules. See sections 296-20-01030 (Minimum health care provider network standards) and 296-20-01050 (Health care provider network further review and denial).
- What are the standards for participation in the network?
After providers are admitted to the network, they will be required to meet standards to participate in the network. These standards are described in the network rules. (See new section 296-20-01040 Health care provider network continuing requirements.)
- Could a provider be removed from the network? And, if so, why and how would L&I remove them?
L&I could remove a provider from the network if they:
- Put injured workers at risk of harm.
- Fail to maintain network credentialing standards.
- Do not follow other L&I requirements, such as administrative policies.
Detailed information is available in the network rules. See section 296-20-01040 (Health care provider network continuing requirements) and section 296-20-01100 (Risk of harm).
If L&I has concerns about a provider, we will work with them whenever possible regarding compliance with requirements before removing them from the network. In the network rules, L&I has defined processes for providers to request reconsideration if they are removed from the network. See new section 296-20-01030 (Request for reconsideration of department decision).
- Who decided on the standards for enrollment and participation?
L&I developed the network standards based on the recommendations of the Provider Network Advisory Group as well as other research and input. The standards were adopted through a formal rulemaking process, with opportunities for public input.
- Why was it necessary to create a provider network?
High-quality medical care helps both injured workers and their employers, by supporting recovery which reduces unnecessary costs. Research shows that health-care providers using best practices for occupational medicine generally have better outcomes with injured workers. The network will encourage the use of the best practices.
Treating injured workers
- If I'm not the type of provider listed above, or I don't practice in Washington State, can I still treat injured workers?
Yes, you can continue treating injured workers with your existing L&I provider number until we require your provider specialty, or out-of-state providers, to join.
- If I am the type of provider listed above but I don't enroll in the network, can I still treat injured workers?
You can only treat injured workers for an initial office or emergency room visit. For ongoing care, they must transfer to a network provider.
You can apply to enroll in the network at www.JoinTheNetwork.Lni.wa.gov.
- What is the definition of initial visit?
Under existing rules, "initial visit" is the first visit to a health-care provider during which the accident report is completed. This definition has not changed. While often the same, the initial visit isn't always the first date of treatment. Treatment before and after the initial visit (date associated with the completion of the accident report) can only be done by network providers as of January 1, 2013.
Amendments to the Washington Administrative Code (83KB PDF) were adopted to further define what is included in the initial visit, worker and provider responsibilities, and who can provide medical support for reopening claims.
- Do the employees of self-insured companies use the provider network?
Yes, employees of self-insured companies must be treated by network providers after the initial visit. Employees of both self-insured companies and those covered by L&I use the same network.
Top Tier of the network
- What is the Top Tier of the network?
The Top Tier will be a select group of network providers who agree to use certain occupational-health best practices and whose performance meets measures that are being developed. Providers qualifying for the Top Tier will be eligible to receive financial and non-financial incentives, which are also being developed.
- When will the Top Tier of the network begin?
L&I plans to begin the Top Tier in late 2013 or early 2014.
- Will providers get paid more if they qualify for the Top Tier?
Providers that qualify for the Top Tier will be eligible to receive financial and non-financial incentives, such as streamlined authorizations. The incentives are being developed.
- What are the "best practices " for the Top Tier?
For the Top Tier, L&I plans to use best practices that are close to the ones currently used by providers participating in the Centers for Occupational Health Education (COHEs). Other best practices are being developed.
Contact Us
Policy
Leah Hole-Curry, Acting Medical Administrator
360-902-4996
leah.hole-curry@Lni.wa.gov
Provider Network
Gary Walker, MPA
360-902-6823
gary.walker@Lni.wa.gov
Provider Network Advisory Group
Joanne McDaniel, MA, OTR/L
360-902-6817
joanne.mcdaniel@Lni.wa.gov
