If you do not have an organization NPI for each location and request to add each group, please note that this will cause a processing delay if you charge with a vendor`s individual NPI number rather than their L&I vendor account number for each practice site. If you are not one of the types of providers required to join our network, or if you operate outside the state, you must request a vendor account number with L&I. Note: If you are not one of the special types listed below, this is not your application, see Requesting a vendor account (F248-011-000). If you have multiple locations under the same tax identification number with one or more National Organization Provider Identification (NPI) numbers, it is important to know how we set up the accounts. This may result in late or declined payments. Setting up your accounts is an administrative decision. If a provider is applying, see the L&I 2 page, Section 3 of the Washington Practitioners` Application, and the current IRS W-9 form attached for each submitted location. If you are a supplier operating outside of Washington State, you must: It is the supplier`s responsibility to submit the required forms directly to the GFO. L&I cannot accept or submit OFM forms on behalf of the supplier. If you are treating an injured worker for continuing care, beyond the first visit to submit the accident report form, you must be an approved network provider to be paid for the services. Please refer the injured employee to a network provider.

To avoid these delays, you must enter the account number of the individual provider in box 24J of the CMS 1500 billing form or each practice location or the beneficiary number of the group ID in box 33B to indicate where the services were provided. If you are one of the following types of providers, additional requirements apply. To meet these requirements, visit: If a group with multiple sites under the same fiscal ID and the same NPI organization wants its providers configured for each practice site, it must submit a group add package (F245-449-000) for each network provider and site. If you are a provider that provides services outside of the United States, you must submit the following request so that we can pay you for your services provided: L&I switches to ProviderOne, a new registration and login information system. To prepare for the transition, all healthcare providers who are HIPAA entities (individuals or organizations) must receive a National Provider Identifier (NPI). Incoming applications for health care providers cannot be processed without an NFC number. For more information, see: ProviderOne NPI Requirement. Find a network provider for patients who need ongoing care. Allow 60 to 90 days for your application to be reviewed. We will inform you of our decision. If you are accepted, you will receive a letter informing you of your provider`s account number.

If you have not heard from us after 90 days, please email us at PACMail@Lni.wa.gov. Having a vendor account number or reactivating a closed account does not mean that you are on our network. If you do not see that you are a network provider and want to treat an injured worker for ongoing care, you will need to apply. L&I Vendor Number or National Practitioner Identification Number (NPI) If you practice in Washington State and are one of the following types of providers, you must be on our network to care for injured employees beyond the first office or emergency room visit. This includes the treatment of employees of companies covered by L&I, as well as employees employed by self-insured employers: to be paid for services, all suppliers must have an active L&I supplier number. Fill out the appropriate forms by selecting the appropriate tab below, depending on your area of expertise, to obtain a supplier number. Note: Hospitals and facilities do not need to complete the W-8BEN included in the out-of-country vendor account application, as it only applies to individual providers. . To check the status of your application or network, search: 2.

Send your completed L&I application (including additional requirements if specified above) to:. Medical Provider Network Application Packet (F245-447-000) and Washington Practitioners Application (F245-411-000) (WPA) 2. You can send completed L&I forms by fax, email or mail to: If you have any questions about the GFO forms or the registration process, call 360-407-8180 or email: PayeeRegistration@ofm.wa.gov. 8. You will need to reconfirm so that we can receive your request. 6. Verify that the tax identification number on the GFO supplier/beneficiary form (step 2) matches the tax ID on page 2 of the EPA. Changes may result in delays in bill payment and access issues with L&I`s online applications, e.B Provider Express Billing and your My L&I account.

To ensure timely treatment, use the Network Medical Provider Identification Checklist (F245-445-000) to identify missing information. 1. Please read, sign and submit the following first:. 3. The Office of Financial Management (BFI) must register your tax identification number to make payments. You must send the forms directly to the GFO to: To process complete applications, allow 120 days. If additional information is required to process your request, we will contact you. . Incomplete applications or missing information delay account setup and payment for services paid to you. Note: LGE forms (Step 3, below) must be completed at the same time as the EPA submission to avoid possible late payments. 1.

Complete a vendor account application (F248-011-000). 1. Send the request for the provider`s account number (F248-011-000) so that we can pay you for the services provided. To avoid delays, make sure everyone in your organization is aware of the changes. including billing staff and staff at each clinic. . Apply for an NPI at nppes.cms.hhs.gov/#/. Once you have received your NPI, please submit your complete application. Accounts are typically configured based on two scenarios. Here`s what you need to know: Send your complete application by fax or U.S.

mail to: 7. Be sure to check the L&I box in the Attestation tab. In addition, hospitals and institutions must complete Form W-8BEN-E instead of Form W-8BEN. If you represent a hospital or facility, please click on the following link below to download and complete this form: 4. Follow the OneHealthPort start/sign-in instructions to properly set up your account in ProviderSource. . You will receive a letter in the mail as soon as your application has been processed. . Note: If you have already set up an account in ProviderSource, go to step five. . . .