To get paid for services, all providers must have an active L&I provider number. If you don't have a provider number, you will need to complete the appropriate forms, based on your specialty, by selecting the appropriate tab below.

Network Provider Application

Do you need to be in the Medical Provider Network?

Note: If you are not one of the specialty types listed below, this is not your application, see apply for a provider account (F248-011-000).

If you practice in Washington State and are one of the following provider types, you must be in our network to care for injured workers beyond the initial office or emergency-room visit. This includes treatment for workers of business covered by L&I as well as those employed by self-insured employers:

  • Physician (MD & DO)
  • Advanced Registered Nurse Practitioner
  • Chiropractor
  • Dentist
  • Naturopathic Physician
  • Optometrist
  • Physician Assistant
  • Podiatric Physician

How to apply to be a Network Provider

You have two options:

Option 1: Apply on paper

1. Complete, print, and sign the following:

2. Send your application materials to:

Fax: 360-902-4563
Mail:
Provider Accounts and Credentialing
P O Box 44261
Olympia, WA 98504-4261

Option 2: Apply online with OneHealthPort (OHP)

1. Before you begin, first read, sign, and submit the following forms:

2. Submit the following with the completed forms:

  • Request to pull the providers application from OHP
  • Include the providers name, and their
  • Individual NPI number

You may fax, email or mail the completed forms to the following:

Fax: 360-902-4563
Email: ProvNet@Lni.wa.gov
Mail:
Provider Accounts and Credentialing
P O Box 44261
Olympia, WA 98504-4261

3. Follow OneHealthPort's Getting Started/Sign In instructions for setting up your account correctly in ProviderSource. Note: If you already have an established account in ProviderSource, proceed to step four.

4. Apply online through the OneHealthPort website.

5. Make sure you check the L&I box in the Attestation tab.

6. You must re-attest so we may receive your application.

Is your application complete?

Incomplete applications or missing information delays account set up and payment of services to you.

To ensure timely processing, use the Network Credentialing Checklist (F245-445-000) to identify missing information.

What to expect from L&I

To process complete applications, allow 120 days. If additional information is needed to process your application, we will contact you.

You will receive a letter in the mail once your application is processed.

What is my application or network status?

Having a provider account number or reactivating a closed account does not mean you are in our network. If you do not see that you are a network provider and want to treat an injured worker for ongoing care, you must apply.

To check your application or network status, search by:

L&I provider number or National Practitioner Identification (NPI) number

What happens if I don't join?

If you treat an injured worker for ongoing care, beyond the initial visit to file the Report of Accident form, you must be an approved network provider to be paid for services. Please refer the injured worker to a network provider.

Find a network provider for patients that need ongoing care.

Questions?

ProvNet@Lni.wa.gov

Provider Account Application

Provider Account Number (non-network)

If you are not one of the provider types required to join our network, or if you practice out-of-state, you should apply for a provider account number with L&I.

Here's how to apply:

1. Complete a Provider Account Application (F248-011-000).

If you are one of the following provider types, you have additional requirements. To fulfill those requirements, visit:

2. Submit your completed application (including additional requirements, if indicated above) to:

Fax: 360-902-4484
Mail:
Provider Accounts and Credentialing
P O Box 44261
Olympia, WA 98504-4261

Next Steps

Allow 60 - 90 days for review of your application. We will notify you of our decision. If you are accepted, you will receive a letter notifying you of your provider account number. After 90 days, if you haven't heard from us, please email us at PACMail@Lni.wa.gov.

Out of State Provider Application

Out of State Providers - Apply for a Provider Account

If you are a provider who practices Out of the State of Washington, you will need to submit the Provider Account Number Application (F248-011-000) for us to pay you for services rendered.

Submit your completed application to:

Fax: 360-902-4484
Mail:
Provider Accounts and Credentialing
P O Box 44261
Olympia, WA 98504-4261

Next Steps

Allow 60 - 90 days for review of your application. We will notify you of our decision. If you are accepted, you will receive a letter notifying you of your provider account number. After 90 days, if you haven't heard from us, please email us at PACMail@Lni.wa.gov.

Out of Country Provider Application

Out-of-Country Providers - Apply for a Provider Account

If you are a provider who is Out-of-the Country, you will need to submit the Out-of-Country Provider Account Application (F248-361-000) for us to pay you for services rendered.

Submit your completed application to:

Fax: 360-902-4484
Mail:
Provider Accounts and Credentialing
P O Box 44261
Olympia, WA 98504-4261

Next Steps

Allow 60 - 90 days for review of your application. We will notify you of our decision. If you are accepted, you will receive a letter notifying you of your provider account number. After 90 days, if you haven't heard from us, please email us at PACMail@Lni.wa.gov.

How L&I sets up accounts

How L&I sets up accounts, what you need to know.

If you have multiple locations, under the same tax id with one or more organizational national provider identification (NPI) numbers, it's important to know how we set up accounts. It can lead to delayed or denied payments.

How you set up your accounts is an administrative decision. When a provider applies, L&I looks at page 2, section 3 of the Washington Practitioners Application and the Statewide Payee Registration form attached for each location submitted.

Accounts are generally set up based on two scenarios. Here's what you should know:

Scenario 1
  • A group has multiple locations under the same tax id and one organization NPI. In this scenario, L&I only sets up one group payee account for the tax ID and organization NPI listed, regardless of how many locations may be associated with the group. This prevents bills from suspending in our system, which leads to delays in payment of services.
Scenario 2
  • A group has multiple locations under the same tax id with multiple organization NPI's for each location. In this scenario, L&I will set up a group payee account for each location with a separate organization NPI. When a provider applies, attaching page 2, section 3 of their Washington Practitioners Application for each location, L&I will set up an individual provider account for each location that has a separate organization NPI.

If a group with multiple locations under the same tax id and organization NPI would like their providers set up for each practice location, they must submit an Add Group Packet (F245-449-000) for each network provider and location.

If you do not have an organization NPI for each location and you request to add each group, please be aware, this will result in delayed processing if you bill using a provider individual NPI number and not their L&I provider account number for each practice location.

To prevent these delays you must put the individual provider account number in box 24J of the CMS 1500 billing form or each practice location or the group ID payee number in box 33B to indicate which practice location the services were rendered.