Do you need to be in the Medical Provider Network?

New to L&I? Use the "Apply with ProviderOne" tab for enrollment instructions. 

If you are an existing L&I provider and your account has not moved to ProviderOne, follow the instructions below until your account moves.

Note: If you are not one of the specialty types listed below, this is not your application, visit the Provider Account Application tab.

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:

Medical Provider Network Application Packet (F245-447-000) and Washington Practitioners Application (F245-411-000) (WPA)

• • Please follow the instructions in section one of the WPA, and
  • Submit current copies of the documents noted in Section 1.
  • Before submitting your complete application,

Verify the Tax ID on the Office of Financial Management (OFM) Vendor/Payee Registration form (Step 3, below) and the Tax ID on page 2 of the WPA match.

2. Send your application materials to:

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

Note: The OFM forms (Step 3, below) must be completed concurrently with the submission of the WPA 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: ofm.wa.gov/payee  

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. 

Option 2: Apply online with OneHealthPort (OHP)

1. First, please read, sign, and submit the following: 

• Provider Agreement (F245-397-000), and
• A copy of your Federal IRS Form W-9 (for Tax ID listed on WPA, page 2).

Please make sure your request includes: 

• A request to pull the provider application from OHP
• The provider name
• The provider's Individual NPI number

2. You may fax, email or mail the completed L&I forms to the following:

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

Note: The OFM forms (Step 3, below) must be completed concurrently with the submission of the WPA 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: ofm.wa.gov/payee

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.   

4. 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 five.

5. Apply online through the OneHealthPort website.

6. Verify the Tax ID on the OFM vendor/payee form (Step 2) matches the Tax ID on page 2 of the WPA.

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

8. 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 Medical Provider 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?

Email ProvNet@Lni.wa.gov

Provider Account Number (non-network)

New to L&I? Use the "Apply with ProviderOne" tab for enrollment instructions. 

If you are an existing L&I provider and your account has not moved to ProviderOne, follow the instructions below until your account moves.

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:

• Chiropractic consultant
• Independent medical examiner
• Interpreter
• Masters Level Therapists (MLTs)* - L&I's Pilot Program
  • MLTs may enroll and provide care in the Crime Victims Compensation program without participating in the MLT pilot
  • *MLTs include Licensed Independent Clinical Social Workers (LICSWs), Licensed Marriage and Family Therapists (LMFTs), and Licensed Mental Health Counselors (LMHCs)
• PGAP® Activity Coach
• Vocational provider
• Work-hardening provider

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

Email: PacMail@Lni.wa.gov 
Fax:     360-902-4484
Mail:
Provider Accounts and Credentialing
P O Box 44261
Olympia, WA 98504-4261

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:  ofm.wa.gov/payee

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. 

Returned Application? 

1. Follow instructions on cover sheet.
2. Send updated application and forms to: 

Email: PacMail@Lni.wa.gov 
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.

Questions?

Email: PacMail@Lni.wa.gov

ProviderOne is an online portal where you can submit an application to enroll with multiple state agencies. For more information about the ProviderOne transition, see our ProviderOne website. 

All providers new to L&I and ProviderOne must apply for an L&I account through ProviderOne. 

• If you are one of the following providers, click on the link below for additional instructions: 
  • Vocational provider and firm
  • Work hardening provider
  • Master Level Therapist (MLT Pilot)
  • PGAP® Activity Coach
  • Schools and Training Programs

Tips for Success

• Upload ALL necessary documents before submitting your application or it will be returned. Returned applications delay payments.
• Use our ProviderOne Access, Guides and Resources for step-by-step instructions to enroll. 
• Click here to continue your application or check its status. You will need your application ID and SSN/FEIN.

Returned Application? 

1. 1. Return to ProviderOne.
   2. Correct missing or incomplete information. 
   3. Use the appropriate enrollment guide. See ProviderOne Access, Guides and Resources.

Questions? 

Email PacMail@Lni.wa.gov

Here's how to apply: 

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

2. If you are one of the following providers, click the link below: 

• • Interpreter
  • Independent medical examiner

3. Submit your completed L&I application and all supporting documents to either: 

Email: PacMail@Lni.wa.gov 
Fax:     360-902-4484
Mail:
Provider Accounts and Credentialing
P O Box 44261
Olympia, WA 98504-4261

4. Avoid payment delays! Go to ofm.wa.gov/payee and submit the Vendor/Payee Registration form directly to the Office of Financial Management (OFM) for: 

• • New enrollment
  • Changes in EFT payments
  • Legal name changes

OFM forms must be submitted at the same time as your Provider Account Application. 

Note: Providers are responsible for directly submitting necessary forms to OFM. L&I cannot accept or forward OFM forms on behalf of the provider. 

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

Next Steps

Allow 60-90 days for application review. We will notify you of our decision. After 90 days, if you haven't heard from us, please email PacMail@Lni.wa.gov. 

Questions? 

Email PacMail@Lni.wa.gov