Washington Administrative Code › Title 296 - Labor and Industries, Department of › Chapter 296-20 - Medical aid rules › STRUCTURED INTENSIVE MULTIDISCIPLINARY PROGRAM (SIMP) FOR CHRONIC NONCANCER PAIN › Section 296-20-12401 - Application process for providers outside the scope of the provider network

Current through Register Vol. 24-14, July 15, 2024
For providers or services not subject to the health care
				  provider network requirements, including treatment at the initial office or
				  emergency room visit, a provider must obtain a provider account number from the
				  department.
(1)
How can a
				provider obtain a provider account number from the department?
In order
				to receive a provider account number from the department, a provider must:
Complete a provider application;
Sign a provider agreement;
Provide a copy of any practice or other license held;
Complete, sign and return a Form W-9; and
Meet the department's provider eligibility requirements as
				  cited in the department's rules.
Notes:
A provider account number is required to receive
								payment from the department, but is not a guarantee of payment for
								services.
Self-insured employers may have additional
								requirements for provider status.
(2)
Provider account status definitions.
Active - Account information is current and provider is
				  eligible to receive payment.
Inactive - Account is not eligible to receive payment based
				  on action by the department or at provider request. These accounts can be
				  reactivated.
Terminated - Account is not eligible to receive payment based
				  on action by the department or at provider request. These accounts can not be
				  reactivated.
(3)
When
				may the department inactivate a provider account?
The department may
				inactivate a provider account when:
There has been no billing activity on the account for
				  eighteen months; or
The provider requests inactivation; or
Provider communications are returned due to address changes;
				  or
The department changes the provider application or
				  application procedures; or
Provider does not comply with department request to update
				  information.
(4)
When
				may the department terminate a provider account?
The department may
				terminate a provider account when:
The provider is found ineligible to treat per department
				  rules; or
The provider requests termination; or
The provider dies or is no longer in active business
				  status.
(5)
How can a
				provider reactivate a provider account?
To reactivate a provider
				account, the provider may call or write the department. The department may
				require the provider to update the provider application and/or agreement or
				complete other needed forms prior to reactivation. Account reactivation is
				subject to department review.
If a provider account has been terminated, a new provider
				  application will be required.
Statutory Authority:
					 RCW
					 51.36.010,
					 51.04.020, and
					 51.04.030. 12-06-066, §
					 296-20-12401, filed 3/6/12, effective 4/6/12. Statutory Authority:
					 RCW
					  51.04.020,
					 51.04.030,
					 51.36.080. 00-09-078, §
					 296-20-12401, filed 4/18/00, effective
					 7/1/00.