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Medical Provider Network Update

Medical Provider Network Update. Janet Peterson, Health Services Analysis Program Manager July 2013. Application Processing Status. Network Enrollment (as of July 24, 2013): Status Number of providers Approved 15,831 Provisional 795*

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Medical Provider Network Update

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

  2. Application Processing Status Network Enrollment (as of July 24, 2013): StatusNumber of providers Approved 15,831 Provisional 795* Nonprovisional: Applied before Jan. 1 952 Nonprovisional: Applied after Jan. 1 1,148 TOTAL APPROVED OR PENDING DECISION 18,726 • *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. Claims Volume of Providers With Applications In Process (July 24, 2013) >25 claims <1% 2-25 claims 7% 1 claim 7% 0 claims 86%

  4. State Fund Claims by Attending Provider’s network status (July 24, 2013) Other pre-1/1/13 application pending decision 3% Provisional 1% Approved 89% Providers who have NOT applied cannot provide ongoing care to injured workers. The counts of pending applications include some providers 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.

  5. Status of denied applications – through July 24, 2013 * Excludes applications subsequently withdrawn. NOTE: Additional denials will likely arise as more applications are reviewed.

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