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Medical Provider Network Update. Janet Peterson, Health Services Analysis Program Manager October 2013. Application Processing Status. Network Enrollment (as of October 11, 2013): Status Number of providers Approved 17,702 Provisional 918*
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Medical Provider Network Update Janet Peterson, Health Services Analysis Program Manager October 2013
Application Processing Status Network Enrollment (as of October 11, 2013): StatusNumber of providers Approved 17,702 Provisional 918* Nonprovisional: Applied before Jan. 1 543 Nonprovisional: Applied after Jan. 1 816 TOTAL APPROVED OR PENDING DECISION 19,979 • *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.
Claims Volume of Providers With Applications In Process (October 11, 2013) 2-25 claims 2% >25 claims <1% 1 claim 4% 0 claims 94%
State Fund Claims by Attending Provider’s network status (October 11, 2013) Other pre-1/1/13 application pending decision 1% Applied after 1/1/13 <1% Did not apply 7% Provisional <1% Approved 92% Providers who have NOT applied cannot provide ongoing care to injured workers. Providers with applications pending decision include some who have received initial denial letters. They have 60 days to request reconsideration, and can continue to treat during this reconsideration period. They cannot treat after the department issues a final denial order, even if they have a BIIA appeal pending.
Status of denied applications – through October 11, 2013 * Excludes 22 applications withdrawn after initial denial. NOTE: Additional denials will likely arise as more applications are reviewed.
