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Provider Newsletter - May 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 October 2012:


Injured workers notified of provider network status

L&I is mailing letters to injured workers with active claims to inform them that their doctors or other health-care providers need to be in L&I’s Medical Provider Network to continue treating them in 2013. The letters tell workers whether their provider is in the network, has an application in process, or has not yet applied.

When a worker’s provider has not yet applied to the network, the letter recommends contacting their provider to encourage them to join or to get a referral to a network provider. So if you haven’t applied yet for the L&I network, you may get calls from your workers’ comp patients. You can apply at www.JointheNetwork.Lni.wa.gov. For referrals, see our directory of network providers.  The directory is updated each business day, and the number of network providers is growing rapidly as L&I processes network applications.

L&I’s mailing to workers also includes a flyer with links to additional information, including a new Question & Answer page for injured workers. In December L&I will mail an update to workers whose providers are not yet in the network. At that time L&I will advise workers to get a network provider. L&I has added resources to help L&I-insured workers who have difficulty finding a new provider.


Countdown: the statewide workers' compensation network begins in 10 weeks

Are you in the network? Remember, effective January 1, 2013, providers must be in the network to treat injured workers beyond the initial office or emergency-room visit.

Provider types that must apply include physicians (MDs and DOs), chiropractors, naturopathic physicians, podiatric physicians & surgeons, dentists, optometrists, advanced registered nurse practitioners, and physician assistants.

If you are one of these types of providers, here’s what you need to know:

  • All current L&I providers must re-apply, including COHE providers.
  • Network doctors will treat injured workers covered by both L&I and self-insured employers.
  • L&I has enrolled many providers through contracts with major group practices.  If you are unsure of your enrollment, please check online at www.FindADoc.Lni.wa.gov or call 360-902-5140.
  • It is taking us 30–60 days to process an application, sometimes longer. We have received a large volume of network applications; verifying provider credentials can be a lengthy process.  If you have submitted a complete application and our review is not complete before the network begins on January 1, we may enroll you provisionally while we finish our review.
  • There is no cap on network enrollment.  We will continue to accept applications and approve providers who meet requirements.
  • Apply now - waiting until the last minute could impact your ability to care for your patients. You can apply at www.JointheNetwork.Lni.wa.gov. If you do not become part of the network, any injured workers in your care will need to move to a network provider not later than January 1, 2013.

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Register for a webinar for emergency department and hospital personnel

We have scheduled two webinars to help emergency department and hospital personnel understand who needs to join the network, who can treat beyond the initial visit, the importance of referring to L&I network providers and the changes to the Report of Accident.  Register now:


Use L&I’s new online directory to find network providers

Our new directory of L&I network providers, www.FindaDoc.Lni.wa.gov, has state-of-the-art search and mapping capabilities. You can search by specialty, city, language and other combinations. You can print or email results lists. Check it out!


Request transfers of care online

Network providers can now request transfers of care for L&I patients at www.Transfercare.Lni.wa.gov. If you are a network provider and are transferring a patient from a non-network provider, your transfer request will be updated immediately. Other requests will automatically receive priority attention from the claim manager.

  • You will be able see the status of your request and can expect a decision from L&I within 3 business days.
  • Once your request is approved, you will have access to that claim in the online Claim & Account Center.
  • You can sign up for email notifications of changes to your transfer requests.
  • When you come back to the site, you will see the status of all your online requests from the last 30 days.

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Changes to the Report of Accident

Watch for your set of new Reports of Accident (ROA) in the mail. We changed the form to clearly identify the date of the initial visit and to explain the need to refer patients to network providers. We have also revised the instructions to highlight the need for a network provider for care after the initial visit.

Starting in November you will be able to order the new ROAs online.


Activity coaching is expanding statewide

If you have injured workers patients struggling with their recovery, a referral to L&I’s Activity Coaching Program can help them increase their quality of life and return to work. L&I has added activity coaches to several locations around the state, so more injured workers can get this help. In addition, coaching is available over the telephone.

So far, L&I has documented results with just a handful of claims, but results are promising. Elsewhere in the United States and Canada the benefits of activity coaching have been well documented. L&I’s program is based on the Progressive Goal Attainment Program (PGAP), a standardized intervention that is delivered by professionals such as occupational therapists or physical therapists who have been trained by the program.

Who should you refer?
Consider referring workers to activity coaching who have between 5 weeks and 5 months of time loss, especially if they appear to have psycho-social issues affecting their ability to return to work.

Who is not a good candidate?
Workers who are not eligible at this time include:

  • Surgery planned or likely.
  • Inability to speak, read, and write in English (materials are not yet available in other languages).
  • Evidence of a drug or alcohol problem.
  • Currently in work hardening.
  • More than 5 months of continuous time-loss.

To make a referral, contact Susan Campbell at susan.campbell@Lni.wa.gov or 360-902-5053. She can help you find the coach closest to you and your patients.

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Learn how to sponsor a COHE — attend a public meeting

We're expanding the Centers of Occupational Health and Education (COHE) as part of 2011 legislation requiring that all injured workers have access to a COHE provider by December 2015. In January 2013, L&I will release a Request for Proposal (RFP) for organizations interested in sponsoring COHEs.

This fall we are hosting public meetings so health-care organizations and providers can learn about the COHE expansion. Your involvement is important to ensure that resources are available to assist injured workers in your community.

Plan to attend one of the following meetings:

  • Tukwila, Oct. 29, 10 to 11:30 a.m., L&I Tukwila regional office
  • Tumwater, Nov. 2, 10 to 11:30 a.m., Headquarters room S117
  • Kennewick, Nov. 5, 2 to 4 p.m., L&I Kennewick regional office
  • Spokane, Nov. 6, 10 to 11:30 a.m., Region 1 CSD Training Center, 8517 East Trent Avenue, Spokane Valley
  • Seattle, Nov. 9, 10 to 11:30 a.m., Seattle regional office
  • Mount Vernon, Nov. 9, 2:30 to 4 p.m., L&I Mount Vernon regional office
  • Kelso, Nov. 15, 10 to 11:30 a.m., L&I Kelso regional office

Contact Susan Campbell, COHE Expansion Coordinator, at susan.campbell@lni.wa.gov or 360-902-5053, for more information.


Filing workers’ comp accident reports online pays

Filing L&I’s Report of Accident (ROA) online is catching on – 17% of all accident reports are now submitted at www.FileFast.Lni.wa.gov

The electronic ROA is easy to fill out. It’s even easier if injured workers complete their ROA through FileFast first, as the worker’s information populates the provider ROA form.

FileFast reduces delays in claim decisions, provides immediate confirmation of claim receipt and speeds provider payments.  In other words, it pays to FileFast!

Other benefits of online claim filing:

  • Provides more space for medical information.
  • Increases accuracy (reduces common mistakes).
  • Assures the ROA is filed within L&I time requirement.
  • Gives providers, employers and workers fast access to the claim in L&I’s online Claim & Account Center.

Providers receive financial incentives for filing accident reports early, and with FileFast they receive an additional $10 reimbursement for filing on the L&I website (code 1040M).  Remember to include the incentive fee on the bill for the ROA.    

Payment for Report of Accident Report – Code 1040M
Payment for Report of Accident – Code 1040M (Fees for Non-COHE Providers)
If received following first treatment date: Max. fee for paper or fax submittal Max. fee for online filing
Within 5 days

$37.84

$47.84

6–8 days

$27.84

$37.84

9 or more days

$17.84

$27.84

For more information, read about the FileFast project or call 1-877-561-FILE (3453).

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Changes in coverage of spinal injections

Labor & Industries recently changed its policy on coverage of spinal injections: they are now covered with certain limitations, effective September 1. Highlights of L&I’s new policy:

  • For state fund claims, all requests for spinal injections require prior authorization by Qualis, the department’s utilization review vendor. For self-insured claims, contact the employer for information.
  • Epidural injections and sacroiliac joint injections are covered with restrictions.
  • Most facet injections, medial branch blocks, and intradiscal injections, are non-covered.
  • The injured worker must have had a course of conservative therapy before starting injections. Improvement in the worker’s function and pain must be documented before and after injections.

Read L&I's complete decision on coverage.

This change aligns L&I policy with the decision made by the State Health Technology Clinical Committee (HTCC) on June 17, 2011. The committee’s decision on spinal injections was based on a review of the best available evidence of safety, efficacy and cost-effectiveness.  For the complete HTCC decision, see www.hta.hca.wa.gov.

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Work Works: Washington Stay at Work aims to get injured workers back on the job


Rehabilitation of an injured worker can be a long road if the individual becomes isolated at home.  The Washington State Department of Labor & Industries (L&I) offers State Fund employers a new incentive program to help keep injured workers on the job when medically appropriate. Called Washington Stay at Work, the program is getting a “thumbs up” from medical providers, employers and injured workers alike.

Stay at Work provides employers with financial incentives to create medically sound light-duty jobs for workers after an injury. L&I is encouraging employers to adopt the philosophy of returning an injured person to work as quickly as medically possible. National studies show that injured workers do much better socially, psychologically and financially when they remain at work after an injury.

Many providers already routinely ask injured workers and their employers if they have a light-duty job description, or transitional job description, at the first medical appointment.

We hope that more providers will talk with workers and employers about light-duty or transitional jobs — and be sure to tell them that the Stay at Work will reimburse employers 50 percent of the base light-duty wage of the injured worker, up to $10,000 per claim or 66 days, whichever comes first. Additionally, reimbursements are available for equipment, training and clothing required to carry-out light-duty assignments. 

To date, the program has reimbursed more than 1,200 employers more than $6.7 million to support approximately 3,000 injured workers state-wide. 

Employers have been enthusiastic about the financial reimbursements, but they can also see how quickly an injured worker can recover with their employer’s support.  

Stay at Work is a win-win for the injured work, employers and medical providers. 

More details about the program can be found at www.StayatWork.Lni.wa.gov.

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