What is the L&I website?
Plenty of information is available on the L&I website www.lni.wa.gov.

What if the patient doesn't want to open an L&I claim for an injury that occurred at work?
It is fraud to bill a persons' insurance for an injury sustained at work.

What if the claim is not accepted?
Part of being an attending provider for L&I is determining if the injury occured at work. If it is determined that the injury did not occur at work, the provider will still get paid for the initial visit. However, L&I will not cover any subsequent visits.

How to become a provider

Tips

Early Retirement
Some people look at L&I as early retirement. These are the people who are working the system and can be your most difficult patients.

Time Loss
Time loss is a sticky situation. The provider must decide if the injury incurred will prevent the patient from continuing to work. Quite often patients can do light duty; answering phones, clean up, paper shuffling, etc. If you order light duty it is up to the employer to find light duty for the patient. If the employer doesn't have light duty, then it is up to the employer to put the employee off duty. It is then up to the employer to inform L&I. This is an excellent way to get patients back into the swing of things.
Quite often employers don't want their employees on time loss and would prefer to have them on light duty. They will regularly send the patient back to you with a list of tasks.

Billing/Coding

New Office Visit
When opening an initial claim, even for established patients, bill for a new patient visit. (99201, 99202, 99203) After the initial visit, subsequent visits should be charged at the established rate. (99212, 99213, 99214)

Common Codes

• Allowable L&I Billing Codes for ARNPs [PDF]
• 1040M Filling out the accident report form (All new claims)
• 1039M Sending a time loss report
• 1056M Supplemental medical report
• 1041M Reopening application
• 99080 "Special report when requested by the agency or 60 day report."

Phone Calls
Telephone consultations between the Nurse Practitioner and "vocational counselors, employer, claim managers, department nurse consultants, and other department representatives."

• 99371 Brief (Under 15 min.) phone call by NP
• 99372 Intermediate (15-30 min.) phone call by NP
• 99373 Complex (over 30 min.) phone call by NP

Helpful Links

St. Lukes Spokane Center for Occupational Health and Education
http://spokanecohe.stlukesrehab.org/Athena

Washington State Department of Labor and Industries Continuing Education
www.lni.wa.gov/claimsinsurance/providers/education

You must have an L&I number. To apply for this go to the link below and fill out the required paper work.
http://www.lni.wa.gov/ClaimsIns/Providers/Become/default.asp