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Benefits for medical providers caring for OWCP injured/ill workers

There are benefits for medical providers caring for OWCP injured/ill workers.
OWCP is committed to helping medical providers care for our injured/ill workers. Click on the link for more information on the advantages of working with each of the OWCP programs.
Division of Energy Employees Occupational Illness Compensation (DEEOIC)
Federal Black Lung Program (DCMWC)
Federal Employees Compensation Act (FECA) Program

Adding Billing Agency or Clearinghouse to your OWCP Provider Record

Did you know you can add or update billing agency information on Step 8 of your enrollment application or modification? Be sure to see the Quick Reference Guide Updating Provider Information (dol.gov) for more details. A billing agency must be enrolled with OWCP in order to bill on behalf of a provider. Click here to visit the Forms and References page to access the Billing Agent/Clearinghouse Enrollment Template.

Finding DFEC Case Number

Please contact the call center if you need assistance confirming the claimant’s case number. After confirming provider information, callers can obtain the injured worker’s OWCP case number by verifying the claimant SSN, first and last name, date of birth (DOB), date of injury (DOI), and address. Please call the Division of Federal Employees’ Compensation (DFEC) at 1-844-493-1966. When contacting the call center, please be sure to have your 9-digit OWCP provider ID and the claimant’s case number ready to help with your call.

Submitting Medical Documentation

See our Provider Tips for Services for Accepted Conditions.pdf (dol.gov) for links to submit supporting documentation directly to a claimant’s case file.

DFEC Administrative Authorization of Limited Benefits:

Simple/minor CA-1 traumatic injuries with no work time lost may be covered under an administrative code to cover medical expenses up to $1500 or 180 days from the date of injury. If the amount exceeds the established threshold, the claimant’s case will go to formal adjudication. Providers can submit supporting documentation to U.S. Department of Labor, OWCP/DFEC, PO Box 8300, London, KY 40742-8300. Refer to the DFEC Procedure Manual | U.S. Department of Labor (dol.gov) for more information.

The response on an eligibility inquiry will display specific verbiage when the case is in a Administrative Authorization of Limited Benefits status. The image below is an example showing this verbiage: “C4-Open for Medical Treatment up to $1500 within 180 Days of Date of Inquiry". Refer to the tutorial Verify Claimant Eligibility for step-by-step instructions on how to check eligibility.

Claimant Eligibility Inquiry Response Screenshot

Implant Invoices

If an Outpatient bill is submitted with RCC 0274 – 0279 (implants), the manufacturer invoice and itemized statement are required to properly price the implant(s). The manufacturer invoice cannot be dated after the surgical procedure or greater than 6 months before the surgery. Implants are not separately payable for an Inpatient stay. Please refer to the OWCP Fee Schedule for more details regarding implant pricing.

Covered Procedure Codes

Providers can review list of covered procedures codes by accessing the “CPT, HCPCS, ADA & OWCP Codes with RVU and Conversion Factors” file from the OWCP Fee Schedule. Please be sure to acknowledge the disclaimers and select the appropriate year before accessing the file.

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