WAC 296-20-022
Payment of out-of-state providers. (1) How
will health care providers outside of Washington state be paid?
All health care service providers, regardless of their geographic
location, will be paid according to the fee schedule rules,
rates, coverage and payment policies as published in the
Washington state Medical Aid Rules and Fee Schedules and/or
provider bulletins.
(2) Can an injured worker be charged for services? In all
cases, the department's maximum allowed fees and payment levels
are the maximum payable. If a provider's charge exceeds the
maximum amount payable under the department's Medical Aid Rules
and Fee Schedules, the provider must not charge the injured
worker for the difference. A provider violating this provision
may be held ineligible to treat injured workers as provided by
department rules and may be subject to other applicable
penalties.
Exception:
When a provider treats an injured worker for condition(s) unrelated to the worker's accepted industrial injury or illness, the
provider may bill the worker or other insurers for the unrelated services only.
(3) What services will be paid to providers outside of
Washington? Only those diagnostic and treatment services
authorized under the state of Washington medical aid rules, fee
schedules, payment policies, or medical coverage decisions may be
authorized or paid by the department or self-insurer. As
determined by the department of labor and industries, the scope
of practice of providers outside the state of Washington may be
recognized for payment purposes. However, in all cases WAC 296-20-03002 (Treatment not authorized) shall apply.
Specifically, services not authorized under Washington workers
compensation rules, fee schedules, payment policies, or medical
coverage decisions will not be paid, even if permitted under the
workers compensation program in the provider's state or country
of business. When in doubt, the provider should verify coverage
of a service with the department or self-insurer.