Updated November 2022
Disclaimer: Every effort was made to ensure this manual’s accuracy. However, in the unlikely event of an actual or apparent conflict between
this document and department rule, the department rule controls.
Modifying your Group or
Facility/Agency/Organization/
Institution (FAOI) ProviderOne
account
ProviderOne User Guide
Table of Contents
Modify your group or FAOI provider account ............................................................... 1
Provider enrollment links ...................................................................................................................... 1
Step 1: Modify basic information .................................................................................... 2
Adding and changing basic information ................................................................................................ 2
Step 2: Modify locations ................................................................................................... 3
Modify locations ................................................................................................................................... 3
Modify Location details ........................................................................................................................ 3
L&I specific information ........................................................................................................................ 4
Address list .......................................................................................................................................... 4
Add address information ...................................................................................................................... 5
Next ..................................................................................................................................................... 5
Step 3: Modify specializations ......................................................................................... 6
Modifying specializations ..................................................................................................................... 6
Adding specializations ......................................................................................................................... 6
Deleting specializations........................................................................................................................ 7
View submitted items ........................................................................................................................... 8
Step 4: Modify ownership details .................................................................................... 9
Add individual owner .......................................................................................................................... 10
Add organization owner ..................................................................................................................... 11
Delete ownership information ............................................................................................................. 11
Step 5: Modify licenses and certifications ................................................................... 12
Check required credentials................................................................................................................. 12
Modify licenses/certifications .............................................................................................................. 12
Add licenses/certifications .................................................................................................................. 12
Delete licenses/certifications .............................................................................................................. 13
View submitted items ......................................................................................................................... 13
Step 6: Modify training and education ......................................................................... 14
Check required credentials................................................................................................................. 14
Modify training/education type ............................................................................................................ 14
Add training/education type ................................................................................................................ 15
View submitted items ......................................................................................................................... 16
Step 7: Modify identifiers ............................................................................................... 17
Check required credentials................................................................................................................. 17
Modify identifier.................................................................................................................................. 17
Add an identifier ................................................................................................................................. 18
Step 8: Modify contract details ...................................................................................... 20
Step 9: Modify federal tax details .................................................................................. 21
Steps 10-13: Not applicable to L&I providers .............................................................. 22
Step 14: Modify servicing provider information ......................................................... 23
Modify servicing provider information ................................................................................................. 23
Add servicing provider information ..................................................................................................... 23
Provider doesn’t exist in the database ................................................................................................ 25
Delete a servicing provider ................................................................................................................. 25
View submitted items ......................................................................................................................... 26
Step 15: Modify payment and remittance details........................................................ 27
Modifying payment and remittance details .......................................................................................... 27
Adding payment and remittance details .............................................................................................. 27
Electronic Funds Transfer (Direct Deposit) ......................................................................................... 27
Paper check....................................................................................................................................... 28
Electronic Remittance Advice ............................................................................................................. 28
Submission information ...................................................................................................................... 28
Step 16: Not applicable to L&I providers ..................................................................... 30
Step 17: Submit modification for review ...................................................................... 31
Modifying a Group or FAOI provider account Page 1
Modify your group or FAOI provider account
A group provider is an organization of individual providers who offer services. An FAOI provider is a
facility, agency, organization, or institution that doesn’t have servicing providers.
For more information, see the corresponding enrollment guides:
Group
FAOI
The following ProviderOne topics and tasks are covered in this section:
Starting your modification
Tip! Start with the step you want to update. Depending on your change, additional steps may be required
before submitting your modification.
Submitting the modification to ProviderOne
PROVIDER ENROLLMENT LINKS
Start a new provider enrollment application by going to:
https://www.waproviderone.org/ecams/jsp/common/pgNewPrvdrEnrollment.jsp
Resume or track an enrollment application by going to:
https://www.waproviderone.org/ecams/jsp/common/pgTrackPrvdrApplctn.jsp
You’ll need your application ID and the Social Security Number or Federal Employer Identification
Number associated with the account to log in.
Modifying a Group or FAOI provider account Page 2
Step 1: Modify basic information
ADDING AND CHANGING BASIC INFORMATION
In this step you can add additional agencies (if you want to add L&I go to Add L&I to Existing Account
Guide), and you can change:
Provider Name
Organization Name
Email
W-9 entity type
Other organizational information
Note: Disabled fields are grayed out.
After you make your changes, click OK.
Modifying a Group or FAOI provider account Page 3
Step 2: Modify locations
MODIFY LOCATIONS
Click the link of the Location you want to modify.
This step has multiple sections:
o Location Details contains the contact information and start/end date for this location.
o L&I Specific Information provides the data for the L&I Find a Doctor directory.
o Address List: Each location contains a list with three address types:
Location (physical address of primary location)
Important! Include the phone number you want patients to call for each location.
Mailing (the place where you receive mail),
Pay-To (the place where a paper check and remittance advice is sent).
FAOI accounts also contain:
o Facility Details – No. of Licensed Beds and Accreditation.
o Pharmacy Details – Pharmacy Type, Pharmacy Volume, Unit Dose Pharmacy.
MODIFY LOCATION DETAILS
Enter the new or changed information.
Only change the end date if this location is closing.
Click Save.
Modifying a Group or FAOI provider account Page 4
L&I SPECIFIC INFORMATION
This section allows you to choose if this group or FAOI location appears in the Find a Doctor directory
on www.Lni.wa.gov.
Select Yes to have this location appear in the L&I Find a Doctor directory. The remaining fields in
this section are required.
Selecting No disables the remaining fields in this section.
Click Save when finished.
ADDRESS LIST
Click the link of the Address Type you want to modify.
Make your changes
Click Validate Address to verify.
Click OK and Save.
Note: If you Close, changes will not be saved.
Modifying a Group or FAOI provider account Page 5
ADD ADDRESS INFORMATION
To add a Mailing or Pay-To Address:
Click Add Address.
Choose Type of Address from the drop-down, either Location, Mailing, Pay-To.
Select the type of input option:
o Choose Manually Input. Click Address and add location address.
o Or, choose Copy from Location Address to copy a previously entered location.
o Click OK to save or Cancel to close without saving.
o Click Close on the three open windows to return to the BPW.
NEXT
Make additional changes or go to Step 16: Submit Modification for Review.
Modifying a Group or FAOI provider account Page 6
Step 3: Modify specializations
This information is important for your L&I billing. You can modify the end date or add your new
taxonomy, specialty, and subspecialty.
Note: There may be specific requirements for licensure or training for each specialty/taxonomy listed.
MODIFYING SPECIALIZATIONS
Note: Modifying an end date can cause issues with payment. We don’t recommend changing the date
from 12/31/2999 unless the specialty will no longer be used.
ADDING SPECIALIZATIONS
Click Add.
Note: If you’d like to bill for multiple specialties, you’ll need to repeat this step to add each specialty.
Select the appropriate location, or All, from the Location drop-down menu.
o At least one specialty must be selected and added to each provider location.
Choose L&I from the Administration drop-down menu.
Modifying a Group or FAOI provider account Page 7
Choose the Provider Type and Specialty. Don’t enter an End Date. ProviderOne will auto-populate
to 12/31/2999.
The Provider Type selection will populate the options for Specialty, which displays the available
taxonomy codes.
o Use the double arrows to move taxonomy code from the Available Taxonomy Codes box to the
Associated Taxonomy Codes box.
o Select all applicable taxonomies for each license you have to allow for accurate billing.
Click OK to save or Cancel to close without saving.
DELETING SPECIALIZATIONS
Specialties and sub-specialties can only be deleted during the enrollment process. You can end-date your
specialty/subspecialty through the modification step above.
Modifying a Group or FAOI provider account Page 8
NEXT
Complete additional changes or go to Step 19: Submit modification for review.
VIEW SUBMITTED ITEMS
See your changes:
Click Step 4: Specializations.
Note: The screen will show only “Approved” entries.
In the drop-down next to Filter By, select Status.
In the next field, enter IN%. Any entries with an “In Review” status will be displayed.
Note: Enter % to see all entries.
Click Go.
Modifying a Group or FAOI provider account Page 9
Step 4: Modify ownership details
MODIFY OWNERSHIP INFORMATION
You can modify your “Doing Business As” name, address, and other ownership infromation.
Click the blue link in the Owner/ME/BOD ID column.
Enter the new or changed information.
o Click Address to enter new address information.
Click Save or Close to close without saving.
Modifying a Group or FAOI provider account Page 10
ADD INDIVIDUAL OWNER
Click Add.
Select Disclosure Category Owner or Managing Employee.
Select Disclosure Type Individual.
Enter the individual’s SSN.
Finish the remaining required fields.
o Enter the first day of ownership as the Disclosure Start Date. Don’t enter the Disclosure End
Date, the end date will auto-populate to 12/31/2999.
o Enter an Ownership Percentage. If you have more than one owner, the total percentage of all
owners must equal 100. The organization owner percentage isn’t included in this total.
Click OK to save or Cancel to close without saving.
Modifying a Group or FAOI provider account Page 11
ADD ORGANIZATION OWNER
Click Add.
To auto-populate data, click Copy Name and Tax at the bottom of the screen.
Complete the remaining required fields:
Enter the first day of ownership as the Disclosure Start Date. Don’t enter the Disclosure End Date,
the end date will auto-populate to 12/31/2999.
Click +Address to add the owner’s address.
Enter an Ownership Percentage, e.g. 100.
Click OK to save or Cancel to close without saving.
DELETE OWNERSHIP INFORMATION
Ownership and Managing/Controlling Interest can only be deleted during enrollment. You can end date
your owner record if you use the modify step above.
NEXT
Complete additional changes or go to Step 19: Submit modification for review.
Modifying a Group or FAOI provider account Page 12
Step 5: Modify licenses and certifications
Before clicking into Step 5, review Required Credentials.
Tip: Make note of all requirements. You may use the Required Credentials tool for multiple steps.
CHECK REQUIRED CREDENTIALS
Click Required Credentials from the BPW.
To view the License Requirements, use the Filter By drop-down to select 01-License and click Go.
License(s) will be displayed, if required.
When finished, click Cancel to close.
MODIFY LICENSES/CERTIFICATIONS
Click the blue hyperlink in the License/Certification # column.
Enter new or changed information.
ADD LICENSES/CERTIFICATIONS
Licenses/Certifications may be required for each location with an added specialization. If you have a
DEA number, you can enter it in this step.
Click Add.
Modifying a Group or FAOI provider account Page 13
Use the Location drop-down to add a license or certification to a specific provider location.
Select “All” only if the license pertains to every location.
Complete required fields and click OK to save or Cancel to close without saving.
DELETE LICENSES/CERTIFICATIONS
Licenses and certifications can only be deleted during the enrollment process.
NEXT
Complete additional changes or go to Step 19: Submit modification for review.
VIEW SUBMITTED ITEMS
See your changes:
Click Step 5: Licenses and Certifications.
Note: The screen will show only “Approved” entries.
In the drop-down next to Filter By, select Status.
In the next field, enter IN%. Any entries with an “In Review” status will be displayed.
Note: Enter % to see all entries.
Click Go.
Modifying a Group or FAOI provider account Page 14
Step 6: Modify training and education
Before clicking into Step 6, review Required Credentials.
Tip: Make note of all requirements. You may use the Required Credentials tool for multiple steps.
CHECK REQUIRED CREDENTIALS
Click Required Credentials from the BPW.
To view the Training requirements, use the Filter By drop-down menu to select 03-Training and
click Go.
Training(s) will be displayed, if required.
When finished, click Cancel to close.
MODIFY TRAINING/EDUCATION TYPE
Click the blue hyperlink in the Training/Education # column.
Enter new or changed information.
Note: Enter 12/31/2999 in the End Date field.
Click Save to save changes or Close to close without saving.
Modifying a Group or FAOI provider account Page 15
ADD TRAINING/EDUCATION TYPE
Click Add.
Use the Location drop-down menu to select All, or the applicable location.
Select the required Training/Education Type from the drop-down menu. If you’re not sure which
applies to you, return to the main BPW page and check Required Credentials.
Finish required fields.
The Start Date is when the training/education started.
The Date Completed is when it was done, e.g. graduation date.
Important! In the End Date field, enter 12/31/2999. You must complete this field to continue
enrollment.
You don’t need to finish the Unit Type or Unit Value field.
Click OK and Close.
DELETE TRAINING/EDUCATION INFORMATION
Training and education can only be deleted during enrollment.
NEXT
Complete additional changes or go to Step 19: Submit modification for review.
Modifying a Group or FAOI provider account Page 16
VIEW SUBMITTED ITEMS
See your changes:
Click Step 6: Training and Education.
Note: The screen will show only “Approved” entries.
In the drop-down next to Filter By, select Status.
In the next field, enter IN%. Any entries with an “In Review” status will be displayed.
Note: Enter % to see all entries.
Click Go.
Modifying a Group or FAOI provider account Page 17
Step 7: Modify identifiers
This step doesn’t apply to all L&I providers. Follow the instructions below if the BPW step is Required.
Before clicking into Step 7, review Required Credentials.
Tip: Make note of all requirements. You may use the Required Credentials tool for multiple steps.
CHECK REQUIRED CREDENTIALS
Click Required Credentials from the BPW.
To view the Identifier requirements, use the Filter By drop-down menu to select 02-Identifier and
click Go.
Identifier(s) will be displayed, if required.
When finished, click Cancel to close.
MODIFY IDENTIFIER
Click the blue hyperlink in the Identifier # column.
Enter new or changed information.
Note: For the End Date field, the date must be in the future (e.g. malpractice policy expiration date). If
the identifier is required for an active specialization and you change the End Date to a past date, you can’t
finish this step.
Click Save to save changes or Close to close without saving.
Modifying a Group or FAOI provider account Page 18
ADD AN IDENTIFIER
Click Add.
Use the Location drop-down menu to select All, or the applicable location.
Use the Identifier Type drop-down to select the required identifier.
In the Identifier Value field, enter your information.
Enter the Start Date and End Date, and click OK to close.
DELETE IDENTIFIER INFORMATION
Identifiers can only be deleted during enrollment. You can change your end date if you use the modify
step above.
NEXT
Complete additional changes or go to Step 19: Submit modification for review.
Modifying a Group or FAOI provider account Page 19
VIEW SUBMITTED ITEMS
See your changes:
Click Step 7: Identifiers.
Note: The screen will show only “Approved” entries.
In the next field, enter IN%. Any entries with an “In Review” status will be displayed.
Note: Enter % to see all entries.
Click Go.
Modifying a Group or FAOI provider account Page 20
Step 8: Modify contract details
This step doesn’t apply to L&I. L&I and Health Care Authority providers shouldn’t enter contract
information in this section.
Modifying a Group or FAOI provider account Page 21
Step 9: Modify federal tax details
MODIFY FEDERAL TAX DETAILS
From the Federal Tax Details list:
Click the link of the form you wish to modify.
Note: To make changes to your Legal Name or W-9 Entity Type, go to Step 1: Basic Information.
Enter new or changed information.
Click OK to save or Cancel to close without saving.
Complete additional changes or go to Step 19: Submit modification for review.
DELETE FEDERAL TAX DETAILS
Adding federal tax details is required for all providers. ProviderOne doesn’t allow you to delete this form.
You can click the W-9 link to modify the information in this step.
Modifying a Group or FAOI provider account Page 22
Steps 10-13: Not applicable to L&I providers
This information is applicable if you’re applying for the Health Care Authority. Instructions can be found
at the Enroll as a Provider website:
https://www.hca.wa.gov/billers-providers-partners/become-apple-health-provider/enroll-provider
Modifying a Group or FAOI provider account Page 23
Step 14: Modify servicing provider
information
This step doesn’t apply to L&I FAOI providers. In ProviderOne, a servicing provider renders billable
services for your organization.
MODIFY SERVICING PROVIDER INFORMATION
Click on the blue hyperlink in the ProviderOne ID column.
Enter new or changed information.
Click Save to save changes or Close to close without saving.
ADD SERVICING PROVIDER INFORMATION
Click Add.
Modifying a Group or FAOI provider account Page 24
Enter the SSN/FEIN of the servicing provider and one of the following: NPI, Application # or
ProviderOne ID.
Enter the Start Date. The End Date will auto-populate to 12/31/2999.
Click Confirm Provider.
o If the provider is not found, go to Provider does not exist in the database.
o If the provider is found, L&I will display in the Available Agencies box.
Click L&I and use the double right arrows to move it to the Selected Agencies box.
In Available Taxonomies, click all applicable taxonomies and use the double right arrow to move it
to the Selected Taxonomies box.
Modifying a Group or FAOI provider account Page 25
Click the Available Locations and use the double right arrows to move it to the Selected Locations
box. More than one may be selected.
Click OK to save or Cancel to close without saving.
Ignore the Social Service Servicing Only Provider List. L&I doesn’t use this.
PROVIDER DOESN’T EXIST IN THE DATABASE
If the provider doesn’t exist in the database after searching with the SSN/FEIN and NPI, you’ll be
prompted to add the servicing provider. See the Enrollment guide for individual servicing providers
for more information.
Click OK to start the enrollment process, Back to return to the previous page, or Cancel to return to
the Servicing Provider List.
Note: If a new enrollment process is started, copy the application ID that’s generated for the servicing
provider. You’ll need that ID to:
Continue the servicing provider application (if you exit before submitting).
Check application status.
Update or add additional information, if requested.
Note: If you have more than one servicing provider in your group, you may add the remaining servicing
providers after your group application is approved. A roster upload process is available, as well.
DELETE A SERVICING PROVIDER
Check the box next to the record you want to delete and click Delete.
o This will delete the association between the servicing provider and your group, but doesn’t delete
the record from ProviderOne.
Modifying a Group or FAOI provider account Page 26
Click Close.
VIEW SUBMITTED ITEMS
See your changes:
Click Step 14: Servicing Provider Information.
Note: The screen will show only “Approved” entries.
In the next field, enter IN%. Any entries with an “In Review” status will be displayed.
Note: Enter % to see all entries.
Click Go.
Modifying a Group or FAOI provider account Page 27
Step 15: Modify payment and remittance
details
Payment information applies to all locations.
MODIFYING PAYMENT AND REMITTANCE DETAILS
Click the location you want to modify in the Location Number column.
Enter new or changed information.
Click Save to save changes or Close to close without saving.
ADDING PAYMENT AND REMITTANCE DETAILS
Click Add.
ELECTRONIC FUNDS TRANSFER (DIRECT DEPOSIT)
Click Electronic Funds Transfer (Direct Deposit).
Enter the required information for Electronic Funds Transfer (direct deposit), the fastest payment
method. No other forms are required.
Modifying a Group or FAOI provider account Page 28
The Payment Notification Preference default is Email Notification. This requires an email entry in
Step 2: Locations.
o If the error message below appears, you didn’t provide an email in Step 2.
Note: If you don’t want to provide an email, change the Payment Notification Preference to
Letter Notification.
o Click Close to close the error message.
o Click Cancel to go back to the BPW and complete Step 2 to continue with EFT enrollment. The
bank will verify your data in approximately 7-10 days.
PAPER CHECK
If changing from EFT to paper check, the EFT detail area will collapse and any existing EFT
information will be removed.
Click Paper Check. The check (warrant) will be mailed to the Pay-to address.
ELECTRONIC REMITTANCE ADVICE
Skip this section. Don’t edit this for your L&I application. You’ll continue to receive your remittance
advice as you do today. If you’re also applying with Health Care Authority, go to the Enroll as a
Provider website for instructions.
SUBMISSION INFORMATION
Use the drop-down menu to select Change Enrollment and enter the name of the person authorized
to provide the payment choice.
Click OK to save or Cancel to close without saving.
Modifying a Group or FAOI provider account Page 29
DELETE PAYMENT AND REMITTANCE DETAILS
You can modify these details, but you can’t delete.
NEXT
Complete additional changes or go to Step 19: Submit modification for review.
Modifying a Group or FAOI provider account Page 30
Step 16: Not applicable to L&I providers
Modifying a Group or FAOI provider account Page 31
Step 17: Submit modification for review
Note: Before submitting your change(s), remember to upload required attachments.
Upload a W-9 for business legal name changes and address changes.
o When completing the W-9 form, print the form and add the wet signature (required by
Washington State).
Note: Your W-9 form must match the information provided in Step 10: Add Tax Details.
o Make sure to sign and date every form.
After uploading your attachments, click Submit Provider Modification.
A pop-up will appear with your modification request number.
Click Close on the Final Submission page.
UPLOAD INFORMATION
Click Upload Attachments.
Click Add Attachments.
Modifying a Group or FAOI provider account Page 32
Use the Attachment Type drop-down menu to select the appropriate type.
Click Choose File.
Select your saved document and click Open, or the equivalent for your system.
The name of the file will appear next to the Choose File button. Click OK.
The document is now uploaded and will display in the Attachment List. If the wrong document is
selected, click the blue X in the delete column.
After uploading required attachments, click Cancel. A pop-up will appear (see below). Click OK to
return.
Upon request, foreign language support and formats for
persons with disabilities are available. Call 1-800-547-8367.
TDD users, call 711. L&I is an equal opportunity employer.
PUBLICATION F248-487-000 [11-2022]
