Is the workers employer self-Insured?
Use the Find a Self-Insured Employer look up tool to determine if an employer is self-insured and look up their third-party administrator contact information. If the employer is self-insured, complete the Provider's Initial Report and submit it to the self-insured employers claim contact.
If you don't agree with a payment received from a self-insurer, you must follow WAC 296-20-125(9), and inquire about it within 90 days of payment to be considered.
You can bill the self-insured employer interest on the balance due when payment isn't made within 60 days of receipt of a proper bill. Use the L&I local code 1159M to bill interest.
Calculate the interest due by using the Self-Insurance Medical Bill Interest Calculator (SIMBIC is currently disabled for repairs).
If the employer is not self-insured, see the Medical Providers page under Claims.
Medical Network Provider Status
Need to look up a medical network provider (MPN) status? Use the Provider Network Status Report lookup (PNSR).
The self-insured employer should be the first point of contact. If you have a problem that you have been unable to resolve, use our online system to report issues.
All disputes must be received in writing.
For bill underpayment disputes only complete and submit the Self-Insurance Medical Provider Billing Dispute form (F207-207-000), or call L&I's Self-Insurance Section at 360-902-6938. For all other disputed issues include the department's claim number on your fax cover sheet, and fax all information to 360-902-6900, or contact L&I's self-insurance receptionist at 360-902-6901, if you need help identifying the department claim number.
The department won’t 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 appropriate ICD coding, the self-insured employer should respond to the billing.