Why Dentists Should Become a Network Provider
Dentists practicing in Washington must join our Medical Provider Network in order to treat injured workers beyond the initial visit. Make sure you apply to be a network provider before treating a patient beyond the initial visit.
- We pay non-network dentists for treatment performed only on the patient's initial visit. The initial visit is when the provider is assisting the injured workers in completing the Report of Accident (ROA) or the Provider's Initial Report (PIR) (F207-028-000) form.
- Most dental treatments do not qualify as an initial visit.
- To provide ongoing treatment and get paid for it, you must be an L&I network provider.
- Become an L&I provider (both network and non-network).
Authorization is required for all dental care
Patients covered by L&I
Complete one of the following:
- The American Dental Association (ADA) claim form. Note: Make sure you select "Request for Predetermination/Preauthorization" in section 1, or
- L&I's Preauthorization Request form (F242-397-000).
Fax the completed form to: 360-902-4567
Note: Completing either of these forms creates a priority work item for the claim manager to review. Please do not fax bills to the above number. We cannot accept or process faxed bills.
Patients covered by a Self-Insured Employer: Contact the Self-Insured Employer.
You must complete and submit a treatment plan and/or alternative treatment plan before authorization can be granted.
L&I adopted the New Bree/AMDG dental guideline for prescribing opioids on April 1, 2018. We encourage you to review the guideline and adopt its best practices.
Here are the changes that may affect your practice:
- In most dental cases, prescribe non-opioid analgesics as first-line treatment for pain control, unless contraindicated.
- Access the state's PMP and review the worker's controlled substance history before prescribing opioids.
- If opioids are warranted, prescribe the lowest effective dose for three days or less (e.g. 8 to 12 tablets) and in combination with first-line treatment.
- Complete a prior authorization form (F252-118-000) if more than a 3-day supply is needed.
This guideline was developed in partnership with a broad advisory group, including members of the Dr. Robert Bree Collaborative, AMDG and dentists in general care and specialty areas. The guideline reflects the best available clinical and scientific evidence and a consensus of expert opinion.
See our Administrative Policies in the Related Resource section below, for more information about:
- Prior authorization
- To qualify for payment
- Services that aren't covered
- Requirements for billing
- Treatment plan requirements
- Where to submit a treatment plan
- Documentation and record keeping requirements