Qualis Health has partnered with the Washington State Department of Labor & Industries (Washington L&I) to provide utilization review services for its Workers' Compensation Program. The success of this program depends on the collaborative relationship between providers, Washington L&I and Qualis Health. Qualis Health provides services to make sure eligible injured workers get the appropriate care where and when they need it.
Services We Provide for Washington L&I
Utilization reviews are conducted on a prospective, concurrent and/or retrospective basis employing Washington L&I's Medical Treatment Guidelines, if applicable; otherwise, Qualis Health applies InterQual criteria.
Qualis Health reviews inpatient admissions, a select list of outpatient procedures, specified advanced imaging studies and physical medicine services.
- Effective January 1, 2014: Revised Medical Treatment Guideline for Shoulder Care
The Department of Labor & Industries (L&I) Industrial Insurance Medical Advisory Committee has updated the Medical Treatment Guideline (MTG) for the treatment of Shoulder Conditions. In addition to revising the criteria for shoulder surgery, this new guideline has been expanded to include diagnosis and non-operative treatment of shoulder conditions. It becomes effective on January 1, 2014.
The Shoulder Conditions Diagnosis and Treatment Guideline, along with all of the L&I treatment guidelines, can be found in the MTG section of the L&I website. The documents are listed in alphabetical order on the "Treatment Guidelines" page. Scroll down to find the "Shoulder Conditions Diagnosis and Treatment Guideline" document.
Qualis Health will begin using the updated Review Criteria for Shoulder Surgery (pages 2-6) on January 1, 2014.
For Group A providers, all shoulder surgery will require submission of chart notes for full clinical review until further notice. Please submit:
- Request for review form
- Physical examination
- Imaging reports
- Documentation of conservative care