Changes to Your Account

Please report changes to your account within 14 calendar days.

Changes may cause bill payment delays and access issues with L&I’s online applications, such as Provider Express Billing and your My L&I account.

To prevent delays, make sure everyone in your organization knows about the changes, including billing staff and staff at individual clinic locations.

Select one of the following options, based upon the type of change to be made:

  • For address, name, account closures or other changes, to your:

  • Expand/collapse Provider Account
  • Providers must submit:

    Note: Individual providers who are changing their name, please include one of the following: Updated Medical License, Marriage Certificate, Divorce Decree or court ordered documents with your new name.

    Facility or hospital changes please include a copy of your medical license or certification under your new name.

    IMPORTANT: For Account closures, you will need to submit the Provider change form only to inactivate your account. If we do not receive your request, your account will remain active in our system and on our website in Find a Doctor.

    Fax or mail all documents to:

    Fax: Mail:
    Provider Account: 360-902-4484
    Provider Network: 360-902-4563
    Provider Credentialing
    PO Box 44261
    Olympia, WA 98504-4261

  • Expand/collapse Independent Medical Examiner (IME) Account
  • Your address or business status changes, notify us using the Approved IME Examiner Update form.

    Fax: Mail:
    IME Examiners: 360-902-4249 Provider Quality & Compliance
    PO Box 44322
    Olympia WA 98504-4322

    • For Tax ID (EIN) or Organization NPI changes, select one of the following:

  • Expand/collapse Network Provider (Washington state MD, DO, DC, DDS, DPM, ND, OD, ARNP and PA)
  • If your clinic is setting up under a new Tax ID (EIN) or Organization NPI, follow these steps:

    You must submit the following for each provider in your clinic or group:

    Note: When inactivating a clinic or group, this inactivates all providers in the group.

    Fax: Mail:
    360-902-4563 Provider Credentialing
    PO Box 44261
    Olympia, WA 98504-4261

  • Expand/collapse All Other Provider Types (in Washington state and all out of state providers)
  • Individual Providers and Facilities (i.e. hospital, taxi, nursing homes, home modifications)

    You will need to complete the following for each provider in your clinic or your facility:

    Fax: Mail:
    360-902-4484 Provider Credentialing
    PO Box 44261
    Olympia, WA 98504-4261

  • Expand/collapse Independent Medical Examiner
  • If your clinic is setting up under a new Tax ID (EIN) or Organization NPI, complete the following:

    Update your IME Provider Account Application and submit your new Statewide Payee Registration form.

    Fax: Mail:
    360-902-4249 Provider Qualtiy and Compliance
    PO Box 44322
    Olympia, WA 98504-4322


     

    Questions?

    Provider Network questions, email:  ProvNet@Lni.wa.gov

    Provider Account questions, email:  PACMail@Lni.wa.gov

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