When you treat an injured worker insured by their employer rather than by the State Fund, submit bills directly to the employer or their claims representative.
To determine if an employer is self-insured:
- Check the list of self-insured employers with contact information (this page also includes a list of third-party administrators)
- Call L&I’s Self-Insurance Program at 360-902-6901.
Self-insured employers must authorize treatment and pay bills according to the same Medical Aid Rules and Fee Schedules followed by L&I.
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 now 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.
- Need to look up MPN status? Use the Provider Network Status Report Lookup (PNSR) or download the Provider Network Status Report (PNSR), a daily file of providers' network status.
Need L&I's Self-Insurance Section's assistance?
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).
- Call L&I's Self-Insurance Section at 360-902-6938.
- For all other disputed issues:
- Include the L&I claim number on your fax cover sheet, and fax all information to 360-902-6900.
- Contact L&I's Self-Insurance Program at 360-902-6901 if you need help identifying the department claim number.
ICD-10 Codes: Self-Insured Employer (SIE) Requirements
L&I doesn'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 ICD coding as described below, the self-insured employer should respond to the billing as follows:
|Before October 1, 2015||After October 1, 2015|
|For billing submitted with ICD-9 codes||The SIE would be required to pay based on ICD-9 coding if the bill is overwise payable||The SIE may pay or may return the billing to the provider for proper ICD-10 coding*|
|For billing submitted with ICD-10 codes||The SIE may pay or may return the billing to the provider for proper ICD-10 coding*||The SIE would be required to pay based on ICD-10 coding if the bill is otherwise payable|
|*The SIE must consistently apply whichever approach it takes.|