Pilot Update: Thank you to all the providers who have patiently waited for the Provider Recognition Program pilot. We are working diligently to ensure that this pilot operates smoothly. Please check back in January 2022 for an update on our progress.
If you have any questions, please contact us via email at ProviderRecognitionProgram@lni.wa.gov.
Introducing the Provider Recognition Program (PRP) Pilot
Welcome Washington health care professionals! On this website you can learn about the Provider Recognition Program (PRP) Pilot.
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. The schedule for pilot enrollment and launch will be finalized this winter, and the year-long pilot launches in spring 2022. Enrollment in the pilot is limited to 100 attending providers; please review the steps to enrollment on our "Apply Now" page.
L&I partners with Washington state’s health care providers who treat workers who have been injured on the job. We invite you to learn more about our provider partnerships and Occupational Health Best Practices here.
Benefits of Participating in the PRP Pilot
The PRP Pilot gives us an opportunity to learn from attending providers who treat injured workers and successfully use Occupational Health Best Practices. The pilot is designed to identify program improvements, learning from participating providers’ experience before we make the program widely available.
Promote best practices in patient care for workers who are injured on the job.
Attending providers who participate in the PRP Pilot will help increase awareness and understanding of Occupational Health Best Practices in their community of peers and colleagues. It’s another way you can help improve patient outcomes, even beyond your practice.
Receive increased financial compensation on claims payment, in connection with a high standard of patient care through demonstrated excellence in Occupational Health Best Practices. 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. Compensation during the pilot includes:
- $385 for each new worker in addition to initial visit charges.
- $850 for each new worker who has a complex claim. This incentive is divided into two billed payments.
- $250 for your Health Services Coordinator to assist you with a new worker who has a complex claim.
- Download more information and guidelines about engaging with complex claims during the pilot.
Help educate L&I and improve the design of the Provider Recognition Program.
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 eligible to apply to join the PRP Pilot.
- Participants in the pilot must submit all forms and claim information electronically. Electronic submissions ensure 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 and can improve patient 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 and report on best practice measures.
Goals of the PRP Pilot
L&I wants to reward attending providers’ successful use of Best Practices and learn from pilot participants to fine tune this updated program before it's made widely available. During the pilot, we'll measure adoption of Best Practices and how they're used as well as Utilization Review rates. Health Services Coordinators will also be measured on their standard work requirements.
The PRP Pilot, like the Centers of Occupational Health & Education (COHE) and other L&I provider partnership programs, has a goal to promote and expand the use of Occupational Health Best Practices. The Best Practices can help reduce long-term disability rates among patients who are injured on the job. Key differences between COHE and PRP include:
- PRP providers and their HSCs work with the worker for the life of the claim or until Maximum Medical Improvement.
- Unlike COHE, PRP is not a quality improvement program; it is a recognition and incentive program.
- Unlike COHE, PRP reimbursements are based on incentives, and there is a different process for addressing complex claims.
Occupational Health Best Practices: what they are, and why they matter
Over the past 10 years, L&I, provider partners, University of Washington research, and the business community have identified a set of Occupational Health Best Practices.
These Occupational Health Best Practices are administrative standards for care that help patients avoid long-term disability and return to work as soon as appropriate. Our data shows that when providers adopt 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, allowing L&I to move quickly so we can authorize reimbursement for services and get bills paid faster.
- Assure patients who have been injured on the job that the care they receive has been reviewed for effectiveness.
Best Practices and the PRP Pilot
To promote and increase the use of Occupational Health Best Practices in Washington State, L&I has developed the PRP Pilot, and other initiatives, that offer financial and non-financial incentives to recognize and reward health care providers who implement these Best Practices.
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. You may notice that these Best Practices span multiple programs that L&I offers. The PRP Pilot has specific expectations regarding these Best Practices that are not required by the other programs. Please make sure to review both the information in the table below and the one-pagers to make sure you fully understand PRP Pilot expectations. Collaboration and coordination with Health Services Coordinators and administrative staff is required 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
Download the guidelines for Best Practice 3
|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 patient who has been injured on the job. You must treat at least one patient with a time-loss claim per year to be eligible for this pilot.
Attending providers who wish to join the PRP Pilot must meet the following eligibility criteria:
- Work as an active attending provider or emergency provider, with an active provider ID in L&I’s Medical Provider Network (MPN). You or your physician assistant may not be in interim status.
- Work in one of these professional specialties: Physician, Physician Assistant, Osteopath, 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.
- Have consistently (over the last six calendar months) met or exceeded high adoption measures in each of the Occupational Health Best Practices. Review the Best Practices and success criteria via tab above.
- Have the ability to file needed forms electronically through L&I’s online systems.
- Have a Utilization Review rate of 100%. Review more information about the Utilization Review process. L&I contracts with COMAGINE to provide Utilization Review acceptance rate percentages for each provider within our system. We expect all providers participating in the PRP Pilot to obtain a 100% acceptance rate.
- Have a Health Services Coordinator identified to support workers' compensation claims for patients you are treating. If you are a provider currently working within a Center of Occupational Health & Education (COHE), you have access to a Health Services Coordinator (HSC) to support your work.
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
Pathway to Pilot Enrollment
- Demonstrate knowledge of workers' compensation and Occupational Health Best Practices through a knowledge test which will be available in November 2021. Time estimate: 2 hours.
- We allow three attempts of the assessment before you are disqualified from applying to the pilot. The purpose of the assessment is not only to test your knowledge but to allow us to understand where we lack in supporting you.
- After receiving your successful assessment results, L&I will review the past six months of your utilization review rates and data in connection with Best Practices 1 and 2. L&I measures Best Practices for all state fund claims. Providers may still maintain their self-insured claims but these will not be considered during the pilot for incentives.
- Submit your application for the PRP Pilot. Time estimate: 20 minutes. Our team will contact you to affirm whether or not your application has been accepted and provide guidelines on the steps to enrollment.
- Complete a pilot onboarding survey. Time estimate: less than 5 minutes.
- Identify a Health Services Coordinator to support workers' compensation claims for the patients you are treating within 90 days of pilot start (if this role was not previously identified). If you're a provider currently working within a Center of Occupational Health & Education (COHE), you have access to a Health Services Coordinator (HSC) to support this work. For more information on HSC work during the pilot, read the "For Health Service Coordinators" section below.
- Demonstrate ongoing high adoption of Best Practices. Time estimate: N/A.
- At six and twelve months during the pilot, L&I will review logged data to assess whether participants are meeting the high adoption requirement of the five Best Practices. L&I reserves the right to disenroll providers who don't meet or achieve pilot eligibility standards.
- Participate in quarterly surveys during the pilot and a post-pilot survey at the end. Time estimate: 5 minutes.
For 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.
- L&I will review all pilot applications, do an assessment of eligibility, and accept eligible applicants. We expect to inform providers of their acceptance or non-acceptance in the pilot on a rolling basis and within 90 days of their initial application.
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.
Enrolled applicants will be asked to complete a pre-pilot assessment to check your understanding of Occupational Health Best Practices and ability to implement them.
- Complete the PRP Pilot application and attestation form. Ensure you have completed the pre-pilot assessment on the "Requirements and Eligibility" tab, above, before submitting your application.
- Email your completed application and attestation form to ProviderRecognitionProgram@lni.wa.gov to submit.
- Complete the pre-pilot survey.
Please contact the PRP Pilot Project Lead with any questions:
Jeana Weekley, Project Lead
Occupational Health Services
Department of Labor and Industries
This page is currently under development. Please check back later!
Health Services Coordinators (HSCs) help providers, workers, and employers.
Their standard work includes (when needed) through the medical treatment period:
- Coordination and tracking of referrals.
- Assessment of barriers to recovery.
- Referral to community services.
- Assistance with medication issues.
- Coordination of return to work.
- Support during transitions of care.
- Ongoing monitoring of recovery.
- Coordination of surgical care.
Each PRP provider must designate a Health Services Coordinator.