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Medical Provider Network Update

Medical Provider Network Update. Janet Peterson, Health Services Analysis Program Manager April 2013. Application Processing Status. Network Enrollment (as of April 18, 2013): Status Number of providers Approved 13,143 Provisional 1,813*

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Medical Provider Network Update

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  1. Medical Provider Network Update Janet Peterson, Health Services Analysis Program Manager April 2013

  2. Application Processing Status Network Enrollment (as of April 18, 2013): StatusNumber of providers Approved 13,143 Provisional 1,813* Nonprovisional: Applied before Jan. 1 2,568 Nonprovisional: Applied after Jan. 1 1,364 TOTAL APPROVED OR PENDING DECISION 18,888 • *Includes providers who applied both before and after Jan. 1st who meet criteria for provisional enrollment in WAC 296-20-01020. • All Provisional providers can currently bill and be paid for ongoing care for injured workers, as can others who applied before Jan. 1st and have applications still pending.

  3. State Fund Claims by Attending Provider’s network status (4/18/2013) Other pre-1/1/13 application pending decision 12% Provisional 4% Approved 76% L&I adopted an Emergency Rule so that providers who applied before January 1, 2013 are allowed to continue to treat injured workers and be paid for services until L&I issues a final decision on their application. This group includes some providers who have received initial denial letters (w/ 60 days for reconsideration). Providers who have NOT applied cannot provide ongoing care to injured workers.

  4. Claims Volume of Providers With Applications In Process (April 18, 2013) >25 claims 1% 2-25 claims 16% 1 claim 13% 0 claims 70%

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