Free F248-025-000 mailing addresses - Washington


File Size: 108.2 kB
Pages: 2
Date: April 28, 2005
File Format: PDF
State: Washington
Category: Workers Compensation
Author: Forms Management
Word Count: 243 Words, 1,597 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.lni.wa.gov/Forms/pdf/248025A0.pdf

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STATE OF WASHINGTON

DEPARTMENT OF LABOR AND INDUSTRIES
PO Box 44000 Olympia, Washington 98504-4000

MAILING ADDRESSES: Send Report of Industrial Injury or Occupational Disease to: DEPARTMENT OF LABOR & INDUSTRIES PO BOX 44299 OLYMPIA WA 98504-4299

Send correspondence for a State Fund claim to: DEPARTMENT OF LABOR & IINDUSTRIES PO BOX 44291 OLYMPIA WA 98504-4291 Send provider account information updates to: DEPARTMENT OF LABOR & INDUSTRIES PROVIDER ACCOUNTS PO BOX 44261 OLYMPIA WA 98504-4261 Send provider bills to: DEPARTMENT OF LABOR & INDUSTRIES PO BOX 44269 OLYMPIA WA 98504-4269 Send refunds to: (Attach a copy of the remittance advice) DEPARTMENT OF LABOR & INDUSTRIES CASHIERS OFFICE PO BOX 44835 OLYMPIA WA 98504-4835

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OLYMPIA TELEPHONE NUMBERS For provider account number information: (360) 902-5140

For Interactive Voice Response call: (re: claim numbers, status information, diagnosis codes, procedure codes, drug restrictions, injured workers, providers and employers) For Provider Assistance line call: (billing or remittance advice problems, authorization other than inpatient, verify diagnosis/procedure codes) For inpatient targeted outpatient authorizations call:

1-800-831-5227

1-800-848-0811

1-800-541-2894

For Electronic Billing Unit call:

(360) 902-6511

For questions regarding self-insurance claims call:

(360) 902-6901

For injured worker's concerns or questions, direct them to call:

1-800-LISTENS (1-800-547-8367)

For questions regarding crime victims claims call:

1-800-762-3716

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