DLI’s New Medical Provider Network – What You Need to Know

          Legislative “reforms” of the workers’ compensation system were approved by the Washington legislature in 2011, under Senate Bill 5801.  These reforms addressed physicians’ care of injured workers by establishing a Medical Provider Network (MPN) and expanding access to Centers for Occupational Health Education (COHE) within the Washington industrial insurance system.   COHEs are community-based organizations that use occupational health best practices to treat injured workers. There are four COHEs in Washington State – in Renton, Spokane, Everett and Seattle – that now treat about 1/3 of the injured workers in Washington State.  It is the goals of this expansion to have 50% of injured workers receive treatment through a COHE by the end of 2013.

          The Department of Labor and Industries provides this video to explain the COHE model:

<iframe width=”640″ height=”480″ src=”https://www.youtube.com/embed/CI2B1tRqAGs?rel=0” frameborder=”0″ allowfullscreen></iframe>


We expect many workers to be placed in a bind in January if their longtime treating physicians have not yet taken steps to enroll in the Medical Provider Network.


          Effective January 1, 2013, all injured workers residing in Washington State will be required to obtain treatment from a provider who has filed the proper paperwork and been approved by L&I to be a member of the Medical Provider Network.  The following types of providers will be REQUIRED to be members in order to treat injured workers:  physicians, chiropractors, naturopathic physicians, podiatrists, ARNPs, physician assistants, dentists and optometrists.  Physical and Occupational therapists, initial office visits or emergency room visits, and all out-of-state providers, are excluded from this requirement. 

          The Department’s goal in establishing this Network is to establish standards for caregivers of injured workers that are similar to those used by most other health insurance companies across the nation.  The Department is also developing criteria for terminating providers from the network, as well as designating a “Top Tier” level that will provide incentives for Network providers who demonstrate “best practices”.  What the Department considers best practices is not defined, but presumably will include encouraging physicians to insure their patients are returned or released to work sooner rather than later.

            As of 8/14/12, the Department had enrolled 13,000 individual and group providers in Washington State into its Network.  This month, the Department will be forwarding notices to all injured workers who currently treat with providers that have not yet signed up to be a member of the new Network.  Workers will be asked to encourage their providers to file the paperwork necessary to join the Network so they will be allowed to continue to provide treatment to them. 


See if your doctor has been approved to participate in the new Medical Provider Network on the “Find a Doctor” page.


          The Department provides an updated listing of providers that are currently signed up with the Medical Provider Network on its “Find a Doctor” page.   If you do not see your medical provider on this list, you should discuss with your doctor their plans for enrolling as soon as possible. 

          We expect many workers to be placed in a bind in January if their longtime treating physicians have not yet taken steps to enroll in the Medical Provider Network.  If you discover your treatment provider does not intend to enroll in this required program, you will want to request a referral to another provider. 

          Feel free to contact Causey Law Firm for questions or concerns about requirements for transferring care and any other questions you have regarding the new Network.

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