Please review all components of the web page and the PRP User Manual to assist with your application process.
Good news! You can download and submit your PRP application now!
The HSC training modules are being added to the Health Services Coordination training web page. The modules specific to PRP will be added to the Health Services Coordination tab on the PRP web page.
Introducing the Provider Recognition Program (PRP) Pilot
Welcome Washington attending providers! The PRP Pilot is a state-wide recognition program that offers financial and non-financial incentives to eligible attending providers who are high adopters of occupational health best practices. Enrollment in the pilot is limited to 100 attending providers; please review the steps to enrollment on our "Apply Now" page.
Benefits of Participating in the PRP Pilot
The PRP Pilot gives us an opportunity to learn from attending providers who treat workers and successfully use occupational health best practices. The pilot is designed to identify program improvements before we make the program widely available.
PRP Pilot participants receive increased compensation on claims, and L&I will provide financial reporting to update you on how much you’ve received while participating.
- $385 for each new worker in addition to initial visit charges, when the PRP attending provider is also enrolled in COHE
- $350 for each new worker in addition to initial visit charges, when the PRP attending provider is not enrolled in COHE
- $850 to the new PRP attending provider on a complex claim *
- $250 to the new PRP HSC on a complex claim *
* At this time, the complex claim incentive has been delayed and is not part of the PRP pilot.
Other Benefits of Participation in the PRP Pilot
- Participating in the pilot is a new opportunity for providers who haven't been a part of a Center of Occupational Health & Education (COHE) and want to access incentives in connection with the use of occupational health best practices. Current attending providers working within a COHE are also eligible to apply to join the PRP Pilot.
- Participants in the pilot must submit Report of Accident and Activity Prescription Forms electronically. Electronic submissions ensures provider information is received by L&I quickly so claim managers can respond to provider requests in a timely manner, and so L&I can measure provider use of occupational health best practices accurately.
- Participation in this PRP Pilot requires providers to identify a Health Services Coordinator as part of a provider’s care team for patients injured on the job. For providers adding a Health Services Coordinator for the first time, this change supports occupational health best practices, provides a resource that can address the provider's L&I questions, and can improve worker outcomes. Health Services Coordinators work with all the parties on a claim to advocate on the provider’s behalf, and work with the provider to monitor occupational health best practice performance. Health Services Coordinators will be measured on their standard work requirements.
Key differences between COHE and PRP include:
- PRP Health Services Coordinators work with the worker until maximum medical improvement.
- Unlike COHE, PRP is not a quality improvement program; it is a recognition and incentive program.
- PRP includes financial and non-financial incentives to assist in addressing complex claims.
Occupational Health Best Practices: what they are, and why they matter
Over the past 10 years, L&I and University of Washington research have identified a set of occupational health best practices.
These occupational health best practices are administrative standards for care that help workers avoid long-term disability and return to work as soon as medically appropriate. Our data shows that when providers adopt these best practices, and are supported by a Health Services Coordinator, their patients have better health outcomes.
In addition to improving patient outcomes, using occupational health best practices helps L&I process claim requests more efficiently, reducing delays and allowing L&I to move quickly so we can authorize reimbursement for services and get bills paid faster.
Attending providers who participate in the PRP Pilot MUST demonstrate high adoption of all five occupational health best practices. Please see the table below and links to download our one-page overviews. Collaboration and coordination with Health Services Coordinators and practice staff is strongly encouraged to achieve best practices.
|Best Practice||What It Is||Why It Matters||How We Measure It||Success Criteria for a PRP Pilot-Eligible Standard|
|1. Report of Accident (ROA)
Download the guidelines for Best Practice 1
|Electronically submit a complete ROA form to L&I in 2 business days or less.
|Providers have critical information to get a worker’s compensation claim started. Evidence shows that incomplete ROA information or delays in submitting can result in long-term disability for patients.||ROA forms are filed electronically with L&I, and include the date of initial injury, the date of treatment, and the submission date of the ROA. Timeliness is measured by comparing the ROA receipt date to the date of treatment.||L&I report data shows that 80% of attending provider ROA forms have been filled completely and within 2 business days.|
|2. Activity Prescription Form (APF)
Download the guidelines for Best Practice 2
|Complete an APF at the first medical visit or when the patient’s physical restrictions change and submit to L&I electronically through the My L&I Portal and File Fast.
|APFs are the most efficient way to communicate a patient’s functional status and limitations to employers and to L&I. When employers do not know their workers’ limitations, it can delay workers’ ability to return to work.
|APFs are filed electronically with L&I within 2 business days.
|L&I report data shows that 80% of attending provider APF forms have been timely and appropriately submitted. |
|3. Employer communication
||Engage in two-way communication about your patient’s return to work with their employer.
|Setting expectations right away assures that everyone knows the plan for your patient’s recovery and return to work.||Documentation, with the appropriate billing codes, are submitted to L&I within the first 12 weeks from the claim established date.||L&I is able to verify regular communication by reviewing submitted billing codes.|
|4. Functional Recovery Questionnaire (FRQ)
*Note: this Best Practice requires collaboration with a Health Services Coordinator
Download the guidelines for Best Practice 4
|Assess any barriers to a patient’s return to work using an FRQ.||Our data shows that losing a sense of connection to the workplace severely impacts a worker’s recovery. It’s important to identify those patients at risk before it happens.||The attending provider’s Health Services Coordinator completes the FRQ in L&I’s OHMS within 6 weeks from the claim established date.||L&I is able to verify by reviewing the case note and billing code. Note that the FRQ must be electronically submitted.|
|5. Opioid Rx
Download the guidelines for Best Practice 5
|Understand L&I guidelines for opioid prescription, choose alternatives first, talk about risks, and keep patients safe when prescribing.||Two prescriptions result in an almost 50% risk of increasing long-term disability and have not yet shown to be effective.||First fill is no more than 3 days fill for non-surgeons and no more than 7 days fill for surgeons.
Transition to chronic opioid therapy: less than 5% of all opioid patients in provider’s practice transition to chronic opioid therapy.
Dosing of chronic opioid therapy is less than 50MG/MED.
|Please download and review the PDF guidelines for Best Practice 5.|
Who is Eligible to Join the PRP Pilot?
Attending providers are eligible to join the PRP Pilot. L&I defines attending providers as the primary provider (listed as an attending provider on a workers' compensation claim) treating a worker.
Attending providers who wish to join the PRP Pilot must meet the following eligibility criteria:
- Maintain an active L&I Provider ID in L&I’s Medical Provider Network (MPN). No PRP enrolled provider may be in an interim status in the MPN. Attending provider credentials include: Physician, Physician Assistant, Dentist, Optometrist, Optician, Chiropractor, Podiatrist, ARNP, Psychiatric ARNP, or Naturopath. Physician Assistants who apply to the PRP Pilot must have their supervising physician already participating in the pilot.
- A passing score on our workers' compensation knowledge test. Please allow yourself 2 hours to take this test. Links are provided to each knowledge area.
- Have consistently (over a six-month period) met or exceeded high adoption measures in each of the occupational health best practices.
- Have the ability to file the Report of Accident and Activity Prescription Form electronically through L&I’s online systems, and bill L&I electronically.
- Meet utilization review (UR) criteria. This measure is based on two elements: the number of requests a provider submits and the percentage of COMAGINE acceptances for those requests.
- 1 to 24 UR requests (spinal injections and advanced imaging) requires a 100% approval rate.
- 25 or more UR requests (spinal injections and advanced imaging) requires at least a 90% approval rate.
- Review more information about the Utilization Review process. L&I contracts with COMAGINE to provide UR services.
- Have a Health Services Coordinator identified to support workers' compensation claims for workers you are treating. If you are a provider currently working within a Center of Occupational Health & Education (COHE), you may have access to a Health Services Coordinator (HSC) to support your work. Please contact your COHE for more information.
All applying and enrolled providers must participate in Pilot surveys and other feedback activities.
Still unsure if you can apply to join the PRP Pilot? Use this tool to see if you're eligible. Time estimate: 5 – 10 mins
Health Service Coordinators
If you're a Health Services Coordinator (HSC) supporting an attending provider who is participating for this pilot, you must:
- Be fully onboarded, signed up to My L&I, and have received an L&I provider ID within 90 days of your attending provider’s PRP Pilot application approval. Time estimate: onboarding time varies from approx. 3-10 hours, and the full process can be completed within 30-35 days.
- Adhere to identified HSC Standard Work. Review HSC minimum qualifications, measures, and standard work.
- Respond to any questions or requests from L&I claim managers.
- Respond to any questions or qualitative reviews from the pilot project manager.
- Complete an HSC survey for every quarter of the pilot. Time estimate: 5 minutes.
- Bill your services and submit your case notes in a timely and accurate manner.
- Complete Functional Recovery Questionnaire and pain and function scales on all identified patients.
- Help your provider monitor their occupational health best practice measures and reporting.
Applying for the Provider Recognition Program (PRP) Pilot
Thank you for your interest in applying to join the Provider Recognition Program (PRP) Pilot. Please note enrollment in the pilot is limited to 100 attending providers.
Before you apply, please remember to review the eligibility criteria and requirements to join the PRP Pilot.
Steps to Enrollment
- Review the "About the Pilot" and "Requirements and Eligibility" tabs, above, to understand the goals of this program, benefits of participating, and eligibility and participation requirements.
- Complete the pre-pilot assessment on the "Requirements and Eligibility" tab, above.
- Complete and submit the PRP Pilot application and attestation form, as well as the pre-pilot survey. Email your completed application and attestation form to ProviderRecognitionProgram@lni.wa.gov to submit.
- L&I will review all pilot applications, do an assessment of eligibility, and accept eligible applicants.
We have 100 spots available in the PRP Pilot organized as follows:
- 50 spaces for providers currently working within a Center for Occupational Health Education (COHE) and 50 spaces for non-COHE providers. Each of these 50 slots will then be divided into practices with 10 or fewer staff and practices with 11 or more staff.
- Final assessment will be by region. We will equitably enroll providers based on where their practice sits within L&I Regions.
We process all pilot applications in the order we receive them. You will be informed upon receipt of application whether there is still availability within your slot.
Please contact the PRP Pilot Project Lead with any questions: ProviderRecognitionProgram@Lni.wa.gov
Frequently Asked Questions
Yes, the APF and ROA can be completed and submitted through My L&I on the provider dashboard. In addition, both are also available as a Health Information Exchange (HIE) transactions.
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