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:
   • Master Level Counselors, complete the Master Level Counselor Provider Account Application (F800-053-000).
   • All other provider type, complete L&I’s Provider Account Application (F248-011-000).
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:
   • New Tax ID
   • Enrollment/change for EFT payments
   • Updates to the Legal Name associated with your Tax ID
   • OFM forms can be found by following the link below:
     ofm.wa.gov/it-systems/accounting-systems/statewide-vendorpayee-services

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:
   • New Tax ID
   • Enrollment/change for EFT payments
   • Updates to the Legal Name associated with your Tax ID
   • OFM forms can be found by following the link below:
     ofm.wa.gov/it-systems/accounting-systems/statewide-vendorpayee-services

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)

• Form I: Initial Response and Assessment (F800‑080‑000) Use when treatment is completed within six visits.
• Form II: Initial Response and Assessment (F800‑081‑000) Authorization request for use when treatment will go beyond six visits.
• Form III: Progress Notes (F800‑082‑000) Used to request preauthorization for payment of additional sessions.
• Form IV: Treatment Report (F800‑083‑000) Used to request preauthorization for payment of additional sessions.
• Form V: Termination Report (F800‑085‑000) Used to inform L&I that you are no longer conducting treatment to the client

Mental health billing information

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

• Office of Crime Victims Advocacy
  Washington State Department of Commerce.
• Victim/Witness Notification Program
  The Victim Witness Notification Program of the Department of Social and Health Services is a confidential program that assists victims and witnesses of sexual assault or violent crimes track the location of the person who victimized them.
• Victim Services Program
  The Department of Corrections' Victim Services Program notifies enrolled victims and witnesses when offenders convicted of violent, sex, felony harassment, and serious drug crimes move through the prison system and are released.
• Washington Connection
  Washington Connection offers a fast and easy way for families and individuals to apply for a variety of services such as Food, Cash, Child Care, Long-Term Care, and Medicare Savings Programs.
• Dealing with Death
  This page provides resources regarding your options when a death occurs.
• Washington Vital Certificate Online
  Order birth, death, divorce, and marriage certificates online.
• Washington Coalition of Sexual Assault Programs
• Washington State Coalition Against Domestic Violence
• National Association of Crime Victim Compensation Boards
  Other state crime victim compensation web sites.

Current payment schedule

• 2023 schedule for provider billing cutoff and reimbursements

Mental health billing information

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

Crime Victims Comp Program fee schedule

Fee schedule for mental health providers of crime victims

• Crime Victim Comp Mental Health Fee Schedule, Effective July 1, 2022
• Crime Victim Comp Mental Health Fee Schedule, Effective July 1, 2021
• Crime Victims Comp Mental Health Fee Schedule Effective July 1, 2018