Provider information

Become a Crime Victim Provider

To get paid for services, all providers must have an active L&I or Crime Victim provider account number.

Here’s how to apply:

  1. Based upon your specialty, complete the appropriate application below:
  2. Submit your completed application (including additional requirements, if indicated) to the address or fax number listed on your application.
    Note: The OFM forms (Step 3, below) must be completed concurrently with the submission of the Provider Account Application to avoid potential delays in payment.
  3. The Office of Financial Management (OFM) will need to register your Tax Id to issue payments. You will need to submit forms directly to OFM for:

    For questions regarding OFM forms or the registration process, call 360-407-8180 or email: PayeeRegistration@ofm.wa.gov.

    It is the provider's responsibility to submit the necessary forms to OFM, directly. The Crime Victims Compensation program or L&I cannot accept or forward OFM forms on behalf of the provider.

    Changes to your Account

    Please report changes to your Crime Victims Compensation or L&I account within 14 calendar days, to prevent delays in payment.

    For changes such as Tax ID address or name, business address, billing address, name, complete the following:

    1. Provider Accounts Change Form for Crime Victims Compensation (F800-089-000).
      Note: The OFM forms (Step 4, below) must be completed concurrently with the submission of the Provider Account Change Form for Crime Victims Compensation to avoid potential delays in payment.
    2. Before submitting your Provider Accounts Change Form for Crime Victims Compensation, verify the name and Tax ID on the Office of Financial Management (OFM) vendor/payee form (Step 3, below) and the name and Tax ID on the Provider Accounts Change Form for Crime Victims Compensation match.
    3. Fax or mail your completed Provider Accounts Change Form for Crime Victims Compensation to the address or fax number listed on the form.
    4. The Office of Financial Management (OFM) requires providers/vendors to submit OFM forms to issue payments. You will need to submit forms directly to OFM for:

    For questions regarding OFM forms or the registration process, call 360-407-8180 or email: PayeeRegistration@ofm.wa.gov.

    It is the provider's responsibility to submit the necessary forms to OFM, directly. The Crime Victims Compensation program or L&I cannot accept or forward OFM forms on behalf of the provider.

    Helping Providers Understand the Crime Victims Program (F800-102-000).

    Mental health reporting forms (WAC 296-31-060)

    Mental health billing information

    Mental Health Fee Schedule and Billing Guidelines (F800‑105‑000)

    Victims Information
    Fee Schedule information