Provider Registration

Medium

Prior to receiving reimbursement for a medical service, a practice must complete the Medical Provider Payee Registration form to register with WSI. The medical provider registration establishes a practice's payment, correspondence, medical record request, and primary practice information.

Below are the important elements a practice should be aware of when completing the registration form.

Medium
PROVIDER TYPES REQUIRING REGISTRATION

WSI considers a medical provider to be an entity which supplies a medical service to an injured employee and utilizes a billing National Provider Identifier (NPI). The following types of medical providers must register with WSI:

  • Ambulance
  • Ambulatory Surgical Center (ASC)
  • Chiropractic Clinic
  • Clinic/Center
  • Clinical Medical Laboratory
  • Durable Medical Equipment (DME) Vendor
  • Dental Clinic
  • Hearing Clinic
  • Hearing Air Vendor
  • Home Health
  • Hospice
  • Hospital
  • In Home Supportive Care
  • Massage Therapy Clinic
  • Medical Supply Vendor
  • Mental Health Clinic
  • Nursing and Custodial Care Facility
  • Optometry Clinic
  • Pharmacy
  • Physical/Occupational Therapy Clinic
  • Podiatry Clinic
  • Prosthetic/Orthotic Supplier
  • Radiology/MRI Clinic
  • Speech Therapy Clinic
BILLING NPI INFORMATION

WSI requires a separate Medical Provider Payee Registration form for each group/billing National Provider Identifier (NPI) used to bill WSI. An individual rendering provider associated with the practice does not need to submit a separate registration. Refer to the following chart for registration guidance based on NPI billing structure.

NPI Billing Structure Required Action
 Sole proprietor with a type 1 individual/billing NPI  Submit a single Medical Provider Payee Registration form
 Single practice location with a type 2 group/billing NPI  Submit a single Medical Provider Payee Registration form
 Multiple practice locations share a single type 2 group/billing NPI  Submit a single Medical Provider Payee Registration form
 Multiple practice locations with unique type 2 group/billing NPIs  Submit a separate Medical Provider Payee Registration form for each unique   group/billing NPI

The following are the main elements pertaining to how WSI sets up a medical provider payee account:

  • WSI utilizes the Taxpayer Identification Number and the billing NPI as the main identifiers.
  • WSI sets up a single medical provider payee account for each unique billing NPI, regardless of the number of service locations sharing this same NPI.
  • WSI expects a practice to submit the registered group/billing NPI in Box 33a of the CMS-1500, Box 56 of the UB-04, or in the corresponding 837P and 837I fields for electronic billing.
PRACTICE LOCATION INFORMATION

On the Medical Provider Payee Registration form, a practice must supply demographic information for the primary practice location and additional service locations where an injured employee covered by WSI may receive services. WSI relies on this information to correspond with the practice and individual providers associated with the practice on matters unrelated to payment.

Information must also be provided regarding where WSI should send a request for a medical record. WSI assumes the information supplied in this section is applicable to both the primary practice address and all service locations sharing the same group/billing National Provider Identifier (NPI) unless a practice notifies WSI otherwise.