Prior authorization

Fax requests for the listed hotline-authorized services (for example physical or occupational therapy visits beyond the first 12, using form F245-417-000) to this number. Utilization-reviewed services (inpatient, selected surgery, advanced imaging, spinal injections) go through Comagine Health instead. Applies to State Fund claims; self-insured employers and their third-party administrators handle their own claims in Washington. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.

L&I contracts with Comagine Health (formerly Qualis Health) for utilization review; requests are submitted through the Comagine Health Provider Portal. The fax is published for changes to CPT codes or dates of service on reviewed inpatient/outpatient requests (include a coversheet and the operative report). Phone 206-366-3360 is also published. Applies to State Fund claims; self-insured employers and their third-party administrators handle their own claims in Washington. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.

The L&I Office of the Medical Director UR unit is listed on the UR requirements page for additional information about utilization review. For process questions, not routine request submission. Applies to State Fund claims; self-insured employers and their third-party administrators handle their own claims in Washington. Workers' compensation: a claim number and the adjuster or injured-worker identification are usually required; coverage is determined by the claim (not by a member ID), and state fee schedules and rules govern billing.