The Washington Provider Account Application is a comprehensive form used by providers in the state of Washington to apply for and maintain a provider account with the Department of Social and Health Services (DSS). This form is used by health care providers, such as hospitals, clinics, and laboratories, to register with the state and obtain reimbursement for services provided to DSS clients. The application includes sections on business information, ownership information, and financial information. There are two types of Washington Provider Account Applications: online and paper. The online application is available through the DSS website, and the paper application can be printed and mailed to the DSS.
Washington Provider Account Application
Category:
State:
Washington
Control #:
WA-SKU-3045
Format:
PDF
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Description
Provider Account Application
How to fill out Washington Provider Account Application?
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FAQ
General information. Contact the Washington State Department of Labor & Industries for information about agency programs and services in your language at 1-800-547-8367. Once you are on the phone, please hold a moment while we call an interpreter to help us.
Online via our FileFast tool. By phone: 1-877-561-FILE (3453) At your doctor's office (if you complete the Report of Accident at your doctor's office, the doctor files the form for you)
Employees may also file a claim form online at or by phone at 1-877-561-FILE (3453). Workers' compensation claims must be filed within one year of an injury, and within two years of being notified that an illness is work-related.
If you applied with a paper application, you submit weekly claims by calling the Customer Care Team. If you applied online, file your weekly claims by logging in to your Paid Leave account.
In Washington state, you generally have three years to file your personal injury lawsuit after the date of the accident. Your lawyer will tell you whether to file sooner than the statute of limitations' three-year deadline, but as long as you get those papers filed before the three-year mark, you're in good shape.
The Washington State Tort Claim form may be filed online, by fax, by mail or in person. Submit online. Submit a tort claim online securely.Submit by fax.Submit by mail.Submit in person.Checklist for filing your Washington State Tort Claim form. Frequently Asked Questions.
Go to .Lni.wa.gov/Verify, select the option that applies to you, and search by name. To change your address online, just put in your information and make selections ingly. Update your mailing address, phone number, and email address. Repeat for each of your licenses and certificates.
File a claim online with FileFast (24-hours per day). Workers can also file by phone at 1-877-561-FILE (3453) Monday ? Friday, 8 a.m. ? 5 p.m.
More info
Here's how to apply: 1. Complete the Provider Account Application (F248-011-000). 2.- Review checklists of information needed to complete an application for various provider and supplier types. Learn how to apply for a National Provider Identifier (NPI). Complete your enrollment online using PECOS or submit a paper application. Complete this section if you are a health care provider corporation and you are discontinuing the employment arrangement of a PA(s). Blue Cross Complete Mobile App. Access your account anytime, anywhere. Potential Provider Application. Below are instructional guides that will help complete the CHAMPS application.