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Provider Newsletter - April 2012

Provider News

This is a monthly roundup of L&I news for medical providers. To subscribe by email, join our Medical Provider News email list.

You can also read previous Provider News editions.

In the Provider News for April 2012:


L&I has increased enforcement related to under-payment or non-payment of medical bills by self-insured employers

In March, L&I’s Self-Insurance section began applying penalties when self-insured employers or third-party administrators (TPAs) ignore a final and binding order to pay a medical bill. The penalty is $500 payable to the department.

We are already seeing some success in getting action from self-insured employers and TPAs on these issues. We have worked with a number of self-insured employers and their TPAs to get many outstanding medical bills paid, with interest.

Fair and timely payment is critical to having a pool of high-quality medical providers available to treat injured workers. We hope these changes will improve timeliness and accuracy of bill payment while reducing administrative burden for providers treating injured workers of self-insured employers.

On April 2, L&I also began issuing penalties to self-insured employers that don’t include the L&I claim number on outgoing claim-related correspondence. Self-insured employers can choose to include their own claim number but must include the L&I claim number on the top page of outgoing correspondence.

Questions? Contact Fran Mauritson at daws235@Lni.wa.gov or 360-902-6938.

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Find out about prior authorization requirements — and who to contact — through the fee-schedule look-up tool

We've created an online tool that makes it easy to find out if you must get authorization before providing a service and, if so, who to contact for prior authorization. This tool is part of L&I’s ongoing efforts to reduce the administrative burden of workers’ comp.

When you enter a billing code, the tool will display the prior authorization requirements for that service. For example, if you enter billing code 10040, you’ll learn that you need approval from the claim manager. You can also click on the billing code to review L&I’s fees for that code.

Here's what the look-up tool looks like:

Screenshot of fee-schedule look-up tool

 

(Note that this tool does not include information on pharmaceuticals; for drug authorization information, see Drug Coverage Policies).

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Getting retrospective authorization for medical services

Situations arise where the provider is unable to obtain a pre-authorization before services are delivered, or to notify L&I within 24 hours after admission. In these situations, you can request that L&I evaluate the claim as if those requirements had been met. Read about how to request retrospective authorization.

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Disagree with an L&I code edit for a professional service? Request a review

L&I generally follows nationally-recognized billing policies and code edits. However, differences sometimes arise due to differing interpretations or conflicts among sources for national standards, as well as our unique business needs. If you have an issue with an L&I billing policy or code edit, read about how to request a review of our policy.

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New COHE tool kit now available online

We have developed a new online tool kit to help organizations such as hospitals or clinics that sponsor a Center of Occupational Health and Education (COHE). The toolkit will be useful to existing COHE sponsors as well as to organizations interested in applying to sponsor a COHE in 2013 or 2015.

The new COHE toolkit includes a wide range of templates and examples for understanding how COHEs work. Here are some of the topics:

  • Staffing requirements.
  • Required plans and reports.
  • Enrolling and training providers.
  • Managing a COHE Advisor Program.
  • Health Services Coordinators' role and required training.

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Treating foreign workers on the federal H-2A program: Two tips for fast-track treatment

Agricultural employers in Washington State are increasingly using the federal Department of Labor's H-2A program to hire foreign workers on a temporary basis. Because employers using the federal program are required to provide their employees with worker’s compensation insurance, you may see more injured workers with H-2A visas.

How do I know if my patient is working on an H-2A visa?

Spanish-speaking workers on H-2A visas may not know the official name of the visa program. Many of these workers typically refer to themselves as los contratados and they will know that their contract will end on a specific date. If so, you can assume that they are working here on an H-2A visa.

What do I need to do if my patient is on an H-2A visa?

Make sure the L&I Report of Accident is complete, including a mailing address and contact information in the country of origin. It's also important to:

  • Let workers know they can complete a Report of Accident by phone in many languages by calling L&I at 877-561-3453.
  • Remember that any offer of light-duty positions for these workers must not extend past the expiration date of their visas.
  • Encourage workers to get treatment as often as needed before returning to their countries of origin. If further treatment is needed, the worker should request a provider application packet from L&I to give to a foreign provider or find an existing provider from our website.
  • Advise workers to stay in touch and notify you, L&I, and the employer where they worked of any changes in their contact information.

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