Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Structured intensive multidisciplinary programs (SIMPs) are outpatient programs that deliver regularly scheduled, daily, interdisciplinary care for the treatment of chronic pain. The programs consist of six- to eight-hour days, 5 days per week for two to four weeks duration. The medical services provided in a SIMP are coordinated, goal-directed, and team-based.
SIMP has three phases:
- Evaluation Phase - this phase includes a history, physical exam, medical evaluation to assess candidacy for treatment, and develop a treatment plan and report.
- Treatment Phase - this phase provides coordinated services including PT/OT, patient education, medical management, cognitive behavioral therapy, medication weaning, mental health treatment and vocational rehabilitation.
- Follow-up Phase - this phase includes transitioning the worker back to the community, coordinating with attending provider and maintaining functional improvements.
Conditions of Coverage
SIMP services require referral from the AP and prior authorization from the claim manager. A SIMP evaluation may be authorized if the worker:
- Has had unresolved chronic pain (i.e. pain lasting more than 3 months) despite conservative care, and
- Has one or more of the following conditions:
- Is unable to return to work due to the chronic pain, or
- Has returned to work but needs help with chronic pain management, or
- Has significant pain medication dependence, tolerance, abuse, or addiction
For additional requirements and current SIMP policy, see
List of SIMP providers and locations
- Email: foja235@Lni.wa.gov
- Phone: 360-902-5511
SIMP providers and locations
Northwest Occupational Medicine Center
9400 SW Beaverton Hillsdale Hwy, STE 205
Beaverton, OR 97005-3315
Northwest Return to Work LLC
19221 36TH AVE W, STE 101
Lynnwood, WA 98036-5700
14715 NE Bel Red RD, STE 201
Bellevue, WA 98007-3940
425-644-4100 | firstname.lastname@example.org
9617 7th Avenue SE
Everett, WA 98208
425-513-8509 | email@example.com
1416 East Main, STE F
Puyallup, WA 98372
253-445-8663 | firstname.lastname@example.org
Progressive Rehabilitation Associates
1815 SW Marlow AVE, STE 110
Portland, OR 97225-5186
Rehabilitation Institute of WA
415 1ST AVE N, STE 200
Seattle, WA 98109-4744
Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE)
5701 Maple AVE, STE 100
Dallas, TX 75235
North Texas Rehabilitation Center – Fort Worth Clinic
2601 Scott AVE, STE 102
Fort Worth, TX 76103