SIMP and BIRP Referrals for Spokane Patients: Provider and Claim Manager Guide

Spokane providers dealing with complex workers' compensation cases that have reached a plateau have fewer specialized program options locally. Convivio Health offers SIMP pain management and Brain Injury Rehabilitation through our Renton and Lynnwood locations, and our intake team works directly with providers and claim managers to get travel reimbursement when medically necessary.

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The Referral Challenge

Convivio Health does not have a clinic in Spokane. Injured workers referred to SIMP or BIRP would be reimbursed for travel to our Renton or Lynnwood locations. When standard conservative treatment has not produced meaningful functional progress, an outside-community referral to Convivio Health may be the appropriate next step.

Washington's MARFS guidelines support travel reimbursement when chart documentation clearly explains the medical reason for the referral and why the outside-community option is clinically necessary.

Structured Intensive Pain Program (SIMP)

A holistic approach to chronic pain management through physical conditioning, psychology, and medical management. An intensive, team-based pain rehabilitation program for injured workers with chronic or complex work-related pain who have not responded adequately to prior treatment. SIMP addresses the physical, behavioral, and functional dimensions of pain to restore capacity and support a return-to-work trajectory.

Locations: Renton & Lynnwood

Duration: 3-4 Weeks Intensive

Visit Our SIMP Page

Brain Injury Rehabilitation Program (BIRP)

A structured rehabilitation program addressing the cognitive, behavioral, and functional consequences of a workplace brain injury. BIRP is appropriate for workers experiencing difficulties with memory, concentration, processing speed, behavioral regulation, and work readiness following an occupational head injury or accident

Locations: Lynnwood Only

Duration: 8 Weeks

Visit Our BIRP Page

Initiating the Referral and Evaluation Process

Because Spokane referrals involve a travel commitment for the patient, getting the intake and authorization process right the first time matters. Here is how to initiate a referral effectively:

Start with a fit conversation.
Before assembling a full referral packet, contact the intake team with a brief case summary including diagnosis, treatment history, functional status, and reason for referral. The team can give you a quick read on whether SIMP or BIRP is likely appropriate and what documentation will most support the case. This prevents unnecessary paperwork before fit is established.

Submit the full referral.
Once fit looks promising, send complete documentation through the referral channel. Intake will complete a thorough review, confirm program and location, and open communication with the claim manager.

Build your chart note for travel authorization.
For Spokane referrals, the claim manager's travel authorization decision will involve mileage over a significant distance and likely lodging for multi-day program participation. Your chart notes are the clinical foundation for that decision. Notes should document:
The diagnosis and functional limitations driving the referral
Prior treatments attempted and their outcomes
Why SIMP or BIRP is clinically indicated at this stage
That the appropriate program is not available locally in the Spokane area
Why accessing care at a Convivio Health western Washington location is reasonable and necessary

How Travel Authorization Gets Handled

Travel approval for Spokane-area patients traveling to Renton or Lynnwood is the claim manager's or insurer's responsibility. Multi-day programs for Spokane area patients include overnight lodging and meal reimbursement given the travel distance. Convivio Health can assist the process by:

Providing program descriptions and scheduling information on request

Confirming the appropriate location for the specific program

Coordinating travel reimbursement with WA State L&I.
Coordinating the travel/lodging at local hotels for initial evaluation
Coordinating the travel/lodging at local hotels for treatment

Travel costs including mileage, lodging, meals, and companion travel may be reimbursed by the insurer or claim manager. Confirm what is covered before the patient makes any travel arrangements.

Referral Documentation

Ensure these items are included to prevent delays.

Documentation

Patient demographics and contact

Notes

Required for intake registration

Claim number and date of injury

Links referral to the claim record

Accepted diagnosis

Establishes covered conditions

Claim manager contact

Enables direct coordination

Chart notes (past 60 to 90 days

Core of the clinical fit review

Prior treatment summary

Establishes history and rationale for escalation

Imaging and diagnostics

Relevant for pain and brain injury presentations

Program requested or preferred

Helps focus intake review

Program requested or preferred

Authorization status

Avoids scheduling ahead of approval

How the SIMP Program Helps People Move Forward

Fit inquiry or referral submitted to Convivio intake.

Clinical review completed. SIMP or BIRP fit assessed.

Evaluation pre-authorized. Travel to Lynnwood or Renton arranged for patient.

Initial evaluation completed at Convivio Lynnwood or Renton location.

Evaluation results submitted to insurer. Treatment authorization obtained

Travel is confirmed and treatment is scheduled.

Program begins at confirmed Convivio location.

Frequently Asked Questions Spokane Providers

Why can't Spokane patients access SIMP or BIRP locally?

SIMP and BIRP require a multidisciplinary clinical team and specific infrastructure. These programs are not widely available in the Spokane area. For patients who need them, accessing care at a Convivio Health location in western Washington is often the most viable option.

Does Convivio Health have any presence in Spokane?

Not currently. Referrals from the Spokane area are served through our Renton (SIMP) and Lynnwood (SIMP and BIRP) locations.

Can Convivio support the claim manager's lodging authorization decision?

We can provide program schedule details and appointment information. Lodging authorization decisions remain with the insurer or claim manager based on the program duration and their applicable policies.

Is SIMP or BIRP available via telehealth for Spokane patients?

No. Both SIMP and BIRP are in-person programs. Patients must travel to our Lynnwood or Renton locations to participate.

What documentation should chart notes include for a Spokane referral?

Chart notes should document the clinical reason for SIMP or BIRP, prior treatment history and outcomes, why the program is not available locally in the Spokane area, and why accessing care at a Convivio Health location in western Washington is clinically appropriate and necessary.

Referring a Spokane Patient? Let's Talk Through Fit First.

Referrals from Spokane come with logistics that local referrals do not. Our intake team understands what makes these referrals work clinically, administratively, and practically. Start with a call, and we will help you figure out the right next step.