Changes to your Provider Account

Important Notice: If you are currently receiving payments from L&I, no action is needed at this time.

Effective 7/04/20, L&I will no long be accepting or forwarding the Statewide Payee Registration forms to the Office of Financial Management (OFM). OFM maintains a central vendor file to process vendor payments for all participating state agencies. OFM now requires providers/vendors to submit new Vendor Payee Registration form(s) or changes to existing vendor records(s) directly to OFM.

L&I provider/vendor application packets and forms are currently being updated. Before setting up your account with L&I, you will need to review and submit the appropriate form to OFM to register for payment, if needed. To learn more, visit: ofm.wa.gov/payee

Please report changes to your L&I 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:

Name, Address Changes, or Account Closures

For address, name, account closures or other changes

Providers must: 

1.Complete, print and sign the Provider Account Change (F245-365-000).

2. Changing your name? 

    1. 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.
    2. Facility or hospitals changing their name, please include a copy of your medical license, or certification under your new name.

3. Before submitting your Provider Account Change form to L&I: 

    • Verify the name and Tax ID on the Office of Financial Management (OFM) vendor/payee form (Step 5, below) and the name and Tax ID on the Provider Account Change form match. 
    • On the OFM Vendor/Payee Registration form, circle MIPS use only on the top right hand corner of the form.  (Step 5 below)
    • This will ensure your vendor/payee number is associated to your L&I provider account. 

4. Fax or mail the completed L&I forms to:

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

Note: The Office of Financial Management (OFM) forms (Step 5, below) must be completed concurrently with the submission of the Provider Account Change form to avoid potential delays in payments. 

5. 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: ofm.wa.gov/payee
      • On the OFM Vendor/Payee Registration form, circle MIPS use only on the top right hand corner of the form.  
      • This will ensure your vendor/payee number is associated to your L&I provider account. 

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. L&I cannot accept or forward OFM forms on behalf of the provider. 

6. To close your existing account(s), you will need to submit a Provider Account Change (F245-365-000). If we do not receive your request, your account will remain active in our system and on our website, Find a Doctor.

Tax ID or Organization NPI changes

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

Section 1: 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 SSN) or Organization NPI, follow these steps. You must submit the following for each provider in your clinic or group:

1. Add Group Packet (F245-449-000)

2. Copy of your new Insurance Certificate.

3. Complete the Provider Account Change Form (F245-365-000) to inactivate your current account(s), if you are no longer billing under your existing account, clinic or group. When inactivating a clinic or group, this inactivates all providers in the group.

Note: The OFM forms (Step 5, below) must be completed concurrently with the submission of the Add Group Packet (WPA) to avoid potential delays in payment. 

    • On the OFM Vendor/Payee Registration form, circle MIPS use only on the top right hand corner of the form.  (Step 5, below)
    • This will ensure your vendor/payee number is  associated to your L&I provider account. 

 4. Fax or mail the completed L&I forms (Steps 1-3) to:

Fax: 360-902-4563

Mail

Provider Accounts and Credentialing
P O Box 44261
Olympia WA 98504-4261

5. 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 links: ofm.wa.gov/payee 
      • On the OFM Vendor/Payee Registration form, circle MIPS use only on the top right hand corner of the form.  
      • This will ensure your vendor/payee number is associated to your L&I provider account. 

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. L&I cannot accept or forward OFM forms on behalf of the provider. 

Section 2 - 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 facility:

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

2. Attach a copy of your medical license and/or certification.

3. Fulfill additional requirements if you are one of the following provider types:

4. Complete the Provider Account Change form (F245-365-000) to inactivate your current account, if you are no longer billing under your existing account, clinic or group.  When inactivating a clinic or group, this inactivates all providers in the group.

Note: The OFM forms (Step 6, below) must be completed concurrently with the submission of the above forms to a avoid delays in payment. 

    • On the OFM Vendor/Payee Registration form, circle MIPS use only on the top right hand corner of the form.  (Step 6, below)
    • This will ensure your vendor/payee number is associated to your L&I provider account. 

5. Fax or mail the completed L&I forms (Steps 1-4) to:

Fax: 360-902-4563

Mail:

Provider Accounts and Credentialing
P O Box 44261
Olympia WA 98504-4261

6. 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: ofm.wa.gov/payee
      • On the OFM Vendor/Payee Registration form, circle MIPS use only on the top right hand corner of the form. 
      • This will ensure your vendor/payee number is associated to your L&I provider account. 

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. L&I cannot accept or forward OFM forms on behalf of the provider. 

Independent Medical Examiner

Note:  In addition to the forms noted above, the Office of Financial Management (OFM) forms below,  must be completed and submitted directly to OFM to avoid potential delays in payment. 

Fax or mail the completed L&I forms (above) to:

Fax: 360-902-4249

Mail:

Provider Quality & Compliance
P O Box 44322
Olympia WA 98504-4322

In addition, 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: ofm.wa.gov/payee 
      • On the OFM Vendor/Payee Registration form, circle MIPS use only on the top right hand corner of the form.  
      • This will ensure your vendor/payee number is associated to your L&I provider account. 

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. L&I cannot accept or forward OFM forms on behalf of the provider.