Free Hotline Tips for Medical Services Providers - Washington

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State: Washington
Category: Workers Compensation
Author: Washington State Department of Labor & Industries
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Hotline Tips for Medical Services Providers
Are you using L&I's Interactive Voice Response System and Provider Hotline to your best advantage?
Please read on for tips to help you quickly obtain answers to claim and billing questions. You may also want to use the Claim & Account Center described at the end of this fact sheet.

Utilization Review (UR) ..........1-800-541-2894
Requests for review of inpatient procedures and targeted outpatient procedures as outlined in Provider Bulletin 06-06 should be initiated through our UR contractor, Qualis Health. Fax: 1-877-665-0383

TENS Rental/Purchase .........1-800-999-TENS
Requests for Transcutaneous Electrical Nerve Stimulator (TENS) units should be initiated through EMPI.

Interactive Voice Response Message System......................1-800-831-5227
For most claim and billing questions, your first stop should be the automated Interactive Voice Response (IVR) Message System. Use your provider account number and a touch-tone telephone to access information on the status of State Fund claims, allowed/denied diagnosis and procedure codes, current bill status, and the name of claim managers and their phone numbers. The IVR line is available weekdays between 6 a.m. and 7 p.m. Your Attending Doctor's Handbook provides details.

Crime Victims Claims .............1-800-762-3716
Questions about crime victims claims should be directed to the Crime Victims Compensation Program at Labor & Industries.

Federal Claims ............................ 206-398-8100
(or 206-398-8200)
Questions about federal claims should be directed to the U.S. Department of Labor.

Provider Hotline .......................1-800-848-0811
Medical treatment adjudicators staffing the Provider Hotline can answer your questions on bill payment or denial, provider bulletins and updates, the Medical Aid Rules and Fee Schedule, and applicable sections of the Washington Administrative Code (WAC) or Revised Code of Washington (RCW). The Provider Hotline operates from 8 a.m. to 5 p.m. weekdays. Provider Hotline staff also authorize radiology services and diagnostic testing such as arthrograms, myelograms, bone scans, ct scans, EMGs and NCVs. Hotline staff also assist you by authorizing medical services such as outpatient, non-targeted surgeries, consultations, orthotics, prosthetics, durable medical equipment, hearing aid services, physical therapy, and massage therapy.

What does the coding tell me about a claim?

State Fund claims begin with the letters B, C, F, G, H, J, K, L, M, N, P, X or Y followed by six digits, or double alpha letters (example AA) followed by five digits. Department of Energy claims have seven digits with no preceding letter. Self-insured claims begin with an S, T or W followed by six digits, or double alpha letters (example SA) followed by five digits. Questions about self-insurance claims should be directed to the employer, the employer's service representative or the Self-Insurance section of Labor & Industries at 360-902-6901. continued

Crime Victims claims begin with a V followed by six digits, or VA, VB, VC, VH, VJ or VK followed by five digits.

Where do injured workers call for information?
Questions from injured workers should be directed to the automated IVR line at 1-800-831-5227, the Office of Information and Assistance (OIA) at 1-800-547-8367 or the worker's claim manager.

Federal claims begin with A13 or A14.

Tips for top service from the Provider Hotline

If you are calling for an authorization, please be ready with your provider number, the claim number, procedure codes, dates of service, referring health-care provider and basis for the request. If you are calling about a specific bill, the 17-digit Internal Control Number (ICN) and total bill charge will help us locate the bill more quickly. Please refer to your "Remittance Advice" or the IVR for information on bills submitted within the last 60 days. Remember that L&I is unable to process bills with dates of service more than a year old. Any corrections to your remittance advice need to be brought to L&I's attention within 60 days after you receive it or the payment becomes final and binding. The remittance advice outlines your protest rights. Provider Hotline staff cannot transfer calls from toll-free lines.

Claim & Account Center
Secure. Fast. Get answers online. Who is the claim manager? Has L&I authorized treatment or paid my bill? View claim file documents.* Learn more at .
*This feature is available for self-insured claims as well as State Fund claims. The Claim & Account Center is not available for crime victim or federal claims.

8 On the Web:
Other formats for persons with disabilities are available on request. Call 1-800-547-8367. TDD users, call 360-902-5797. L&I is an equal opportunity employer.

PUBLICATION F248-040-000 [05-2009]