In order to process prescriptions for DOL's FECA program, pharmacies MUST be part of the Optum/Tmesys Retail Network, process real time, and adjudicate electronically. The FECA program stopped accepting batch pharmacy bills in December, 2017 as a step toward this point-of-sale requirement, and the new PBM is the final step.
Effective 4/30/2021, you MUST submit all pharmacy bills point of sale, regardless of date of service, through the Optum network. Thus, ALL pharmacy paper bills must be submitted before 4/30/2021. As of 4/30/2021, DOL will no longer accept pharmacy paper bills for workers compensation medications covered under the OWCP FECA program. All medications must be processed at the point of sale with our PBM or home delivery program contractor, Optum Workers Compensation
In February 2021, the U.S. Department of Labor (DOL) began the implementation of a new contract to provide Pharmacy Benefit Management (PBM) services to the Office of Workers' Compensation Programs' Federal Employees Program for claims covered under the Federal Employees' Compensation Act (FECA). DOL’s new PBM contractor is PMSI, LLC d.b.a Optum Workers’ Compensation Services of Florida (“Optum”).
Optum/FECA pharmacy cards and welcome letters will be mailed to injured federal employees in a phased approach. Before April 1, 2021 welcome packets will be mailed to claimants who have been prescribed opioid medication(s) with daily dosages exceeding the 90 MED (Morphine Equivalent Dose) due to urgent safety concerns. Presently, these claimants receive pharmacy services through First Script/Coventry and will need to transition to Optum. Before April 30, 2021, welcome packets for all other FECA claimants will be mailed.
The use of the Optum/FECA pharmacy program is mandatory for ALL FECA claimants. Prescriptions will not be authorized at the pharmacy on or after the effective date printed on the recipient's card unless the card is presented at a participating pharmacy. If claimants have refills available at a non-participating pharmacy, an Optum/FECA network pharmacy may be able to transfer and receive the remaining refills.
Claimants can search for participating pharmacies on the web (ecomp.dol.gov) or by contacting Optum at 1-833-FECA-PBM (1-833-332-2726). If a pharmacy provider would like to join Optum’s network they should contact Optum at 855-264-8815 or email firstname.lastname@example.org.
OWCP has allowed for the provision of telehealth services without interruption and will continue to do so. However, due to the increased use of telehealth, and to ensure consistency and appropriate billing for such services, the Federal Employees’ Program issued a new policy on 10/22/2020 applicable to injured workers receiving medical care via telemedicine for an accepted work related injury.
FECA Bulletin 21-02 (https://www.dol.gov/agencies/owcp/dfec/regs/compliance/DFECfolio/FECABulletins) establishes the routine medical services that are eligible to be provided by telemedicine, and the specific provider types eligible for reimbursement for these services. Covered telemedicine services are analogous with services payable by the Centers for Medicare & Medicaid Services (CMS) but are not inclusive of all CMS approved services. When billed, correct modifiers and place of service indicators are required. In addition, along with the bill for services, appointment notes articulating the method of telemedicine employed, the length of the visit, any information collected, and the need and benefit derived from the appointment must be submitted at the time the bill is submitted for payment.