OWCP-CNSI Virtual Help Session

OWCP-CNSI will host Virtual Help Session on Friday June 2nd from 3:00-4:00 pm ET. Providers will have an opportunity to ask general questions regarding the medical bill processing system including enrollment, authorizations, billing, and web portal features. Providers will be able to gain insight on helpful information, available tools and to request further assistance.

During this open forum, attendees are not obligated to stay for the full hour

If you are interested in joining, please click this link to register. Attendee name and email are required to register for the event. Once entered, you will receive an invitation with a link to join the event.

Tips for the Virtual Help Session call:

  • Please refrain from referencing specific claimant information or disclosing other protected health information (PHI) during the call
  • Participants can participate via voice or chat during the session
  • The help session will be memorialized via recording and/or transcription to ensure all questions and issues are captured
  • Providers are not required to attend for the duration of the call

We welcome the opportunity to connect with you!

If you need any technical assistance prior to or during the call, please contact WCMBP_TRAINING@cns-inc.com for help.

Authorization Match Improvement - 05-18-2023

Effective May 13, 2023, the OWCP Workers’ Compensation Medical Bill Processing (WCMBP) System will allow authorization match by OWCP ID or Billing NPI for DEEOIC and DFEC bills.

This enhancement will result in decreased denials due to authorization mismatch for providers with multiple locations associated with one billing NPI.

There are no changes to the steps for submitting authorization requests or bills.

Providers should ensure the billing NPI on file is up to date. If the billing NPI associated with your OWCP Provider ID needs to be updated, please use the Maintain Provider Information option on the Medical Bill Processing Portal. Please refer to this link for the Updating Provider Information Resource Guide.

For additional information, please contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Coal Mine Workers' Compensation (DCMWC):
    1-800-638-7072
  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC):
    1-866-272-2682
  • Division of Federal Employees' Compensation (DFEC):
    1-844-493-1966
OWCP Remittance Voucher (RV) Re-design - 05-17-2023

Effective May 13, 2023, the Office of Workers’ Compensation Programs (OWCP) Remittance Voucher will be redesigned for providers and claimants to increase understanding of the payments and associated bill statuses.

Enhancements include, but are not limited to:

  • Adding new Payment, Recoupment, and Overpayment summary tables to explain payments and overpayments
  • Improving the Bill Summary table to explain amount paid in the Bill Payments field, clearly identify overpayments as Amount Due to DOL from this pay period, and show Total Bill Count including total number of Pended Bills (In Process)
  • Improving the Bill Detail table to show Billed Units along with a new column of Paid Units, add the Conflict TCN for lines denying for exact duplicate EOB denial reason 80101, and include new columns Deduction Type and Amount and Net Paid Amount to explain how IRS Backup Withholding or Levies are applied to payments
  • Creating a new Legend to provide a short description of each table

 

Remittance Vouchers will continue to be mailed to the mailing address on file and available in PDF format on the Workers’ Compensation Medical Bill Processing (WCMBP) Portal.

An updated Remittance Voucher (RV) user guide will be available after May 13, 2023 on the WCMBP Portal for providers at Provider Payments | OFFICE OF WORKERS' COMPENSATION PROGRAMS (dol.gov) and for claimants at Claimant's Corner | OFFICE OF WORKERS' COMPENSATION PROGRAMS (dol.gov)

For additional information, please contact us at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Coal Mine Workers' Compensation (DCMWC):
    1-800-638-7072
  • Division of Energy Employees Occupational Illness Compensation (DEEOIC):
    1-866-272-2682
  • Division of Federal Employees' Compensation (DFEC):
    1-844-493-1966

 

New DFEC Durable Medical Equipment Utilization Review - 05-16-2023

Effective May 13, 2023, the Office of Workers’ Compensation (OWCP) Division of Federal Employees’ Compensation (DFEC) Program is implementing new utilization review (UR) for Durable Medical Equipment (DME) procedure codes and modifier combinations.

Please refer to 23-07 DFEC Circular for additional information.

Procedure Code Modifier New Utilization Review Restrictions
E1800. E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1820, E1821, E1825, E1830, E1831, E1840 RR Rental of extension/flexion device is limited to once in 31 days
E0100, E0105, E0110, E0112, E0114, E0621. E0955, E2378 NU Purchase of patient’s sling or seat is limited to once in 366 days
E0670, E0720, E0730, E0748, E0760 NU Purchase of DME equipment is limited to once in a lifetime
E0156, E0158, E0159, E0731, E2102 NU Purchase of DME equipment is limited to once in 1095 days
E1020 NU Purchase of DME equipment is limited to twice in 1825 days
E1028 NU Purchase of DME equipment is limited to six in 366 days
E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0165, E0170, E0171, E0181, E0182, E0183, E0184, E0185, E0186, E0187, E0193, E0194, E0196, E0197, E0198, E0235, E0240, E0245, E0247, E0248, E0250, E0251, E0255, E0256, E0260, E0261, E0290, E0291, E0292, E0293, E0294, E0295, E0301, E0302, E0303, E0304, E0305, E0316, E0471, E0620, E0625, E0627, E0629, E0630, E0635, E0636, E0637, E0638, E0639, E0640, E0641, E0642, E0958, E0968, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1010, E1012, E1029, E1030, E1035, E1036, E1038, E1039, E1050, E1060, E1070, E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1092, E1093, E1100, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172, E1180, E1190, E1195, E1200, E1221, E1222, E1223, E1224, E1225, E1226, E1227, E1228, E1230, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0898, K0899 NU Purchase of DME equipment is limited to once in 1825 days

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

Division of Federal Employees' Compensation (DFEC):
1-844-493-1966

OWCP-CNSI Virtual Help Session

OWCP-CNSI will host Virtual Help Session on Friday May 5th from 2:30-3:30 pm ET.
Providers will have an opportunity to ask general questions regarding the medical bill processing system including enrollment, authorizations, billing, and web portal features. Providers will be able to gain insight on helpful information, available tools and to request further assistance.

During this open forum, attendees are not obligated to stay for the full hour.

If you are interested in joining, please click this link to register. Attendee name and email are required to register for the event. Once entered, you will receive an invitation with a link to join the event.

Tips for the Virtual Help Session call:

  • Please refrain from referencing specific claimant information or disclosing other protected health information (PHI) during the call
  • Participants can participate via voice or chat during the session
  • The help session will be memorialized via recording and/or transcription to ensure all questions and issues are captured
  • Providers are not required to attend for the duration of the call

We welcome the opportunity to connect with you!

If you need any technical assistance prior to or during the call, please contact WCMBP_TRAINING@cns-inc.com for help.

DEEOIC Claimant MBIC FAQs - 04-26-2023

Please click here for DEEOIC FAQs regarding myMatrixx and new DEEOIC program pharmacy benefits.

OWCP-CNSI Virtual Help Session

OWCP-CNSI will host Virtual Help Session on Friday April 14th from 11 am to 1 pm ET.
Providers will have an opportunity to join the call to ask general questions regarding the medical bill processing system including enrollment, authorization submission, billing, and web portal features. Providers will be able to gain insight on helpful information, available tools and to request further assistance.

If you are interested in joining, please click this link to register. Attendee name and email are required to register for the event. Once entered, you will receive an invitation with a link to join the event.

Tips for the Virtual Help Session call:

  • Please refrain from referencing specific claimant information or disclosing other protected health information (PHI) during the call
  • Participants can participate via voice or chat during the session
  • The help session will be memorialized via recording and/or transcription to ensure all questions and issues are captured
  • Providers are not required to attend for the duration of the call

We welcome the opportunity to connect with you!

If you need any technical assistance prior to or during the call, please contact WCMBP_TRAINING@cns-inc.com for help.

OWCP DEEOIC Authorization Improvement - 03-20-2023

Effective April 1, 2023, DEEOIC will implement process improvements for General Medical (GM), Transplant, and Transportation (Medical Travel) authorization requests.

Providers will be able to view the line status of an Authorization Request, including the new status of "Processed - Awaiting Decision," when the authorization line is under DEEOIC review. The status will be updated when a decision has been made by DEEOIC.

There is no change to the process of submitting authorization requests via the online Medical Bill Processing Portal or via the authorization request forms.

Please note that if any changes are necessary for an existing General Medical, Transplant, or Transportation authorization, the provider can submit a new Authorization Request.

For additional information, contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation
    (DEEOIC) 1-866-272-2682
Medical Providers – Effective May 13, Supporting Medical Documentation Required! - 03-15-2023

Effective May 13, 2023, the Division of Coal Miner Workers’ Compensation Program (DCMWC) will require medical providers and facilities to submit supporting medical documentation for services they provide to claimants for their covered black lung conditions. You must attach supporting medical documentation when you submit a Health Care Finance Administration form (HCFA-1500) for professional services rendered in a physician’s office, or a Uniform Medical Billing form (UB-04) for all hospital services except non-emergency services of 24 hours or less (for which you may use either form).

The provider submitting the reimbursement form is responsible for attaching sufficient supporting documentation to substantiate the medical services or supplies billed. The supporting documentation must be attached to the bill submission and must support the billing codes submitted on the reimbursement form. All medical services provided to DCMWC claimants must be documented in the submitted supporting documentation, including the date of service, the miner’s name and date of birth, and a signature of the rendering provider that is both legible and time/date stamped.

More information on how to upload and submit bills and attachments through the Workers Compensation Medical Bill Portal’s Direct Data Entry function is available at https://owcpmed.dol.gov/. This link also has training tutorials to help you get familiar with the entire process.

Please review examples of required supporting documentation that should be attached to bills. For additional details please refer to our letter to enrolled providers.

If you have any questions, regarding the contents of this letter, please contact DCMWC’s medical bill processing vendor at 1-800-638-7072.

OWCP DEEOIC Home Health Procedure Code Updates - 12-17-2022

Effective December 17, 2022, DEEOIC will implement an update to procedure code Authorization and Billing for Home Health (HH) services for reimbursement using hourly and 15-minute incremented procedure codes. In addition, some per-diem Home Health procedure codes will be retired.

Key impacts:

  • Providers will not be required to submit new or corrected authorization requests for authorizations submitted prior to 12/17/22 with retired codes
  • Authorization requests submitted prior to 12/17/22 with retired per-diem codes will continue to be processed.
  • Providers will be able to submit corrections to update units/amount and dates for service lines with retired procedure codes in Approved status after 12/17/22. However, providers will be unable to add new service lines to the same authorization using a retired code.
  • If the approved authorization on file contains retired code(s), Providers should use the code(s) when billing. For example, if an authorization is approved on 12/16/22 for 6 months of per-diem home health services, then the provider should continue to use the per-diem codes for billing through the end of the approved date span.
  • Providers will receive an RTP reason stating that the “Requested Procedure Code is expired or invalid” if a Home Health authorization request with retired codes is received after 12/17/22.

Please refer to DEEOIC Bulletin No.23-03 for more details.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682
TELEHEALTH BILLING GUIDANCE - 12-16-2022

TELEHEALTH BILLING GUIDANCE is presented by the DCMWC to assist providers in understanding acceptable billing codes for telehealth services as they relate to the Black Lung program. Click here for additional information regarding DCMWC telehealth guidelines.

Telehealth Billing Guidance

Coding Chart for Approved Telehealth Services

Ambulatory Surgical Center Services - 11-14-2022

Ambulatory Surgical Centers should bill for facility charges on the OWCP-1500 using the appropriate AMA CPT® code(s) for the primary, secondary, tertiary, etc. procedures and should use the "SG" modifier with each CPT® code.

OWCP Pricing Updated for RCC to CPT Crosswalk - 10-03-2022

Effective October 1, 2022, Outpatient UB-04 billed lines submitted with both the Revenue Center Code (RCC) and a CPT/HCPCS/OWCP procedure code will be priced based on the procedure code fee schedule. This pricing update will apply to bills submitted for DFEC, DEEOIC, and DCMWC.

Please note that there will be no changes for RCC pricing for lines billed without a procedure code.

In addition, this pricing update will not affect the RCC Codes requiring CPT/HCPCS/OWCP Codes for Outpatient Hospital Services, per the OWCP Fee Schedule.

It also will not affect Outpatient Bills (13x or 14x) that are priced via OPPS for DFEC and DEEOIC Programs, or implant lines billed with RCC 0274 – 0279 that require a manufacturer’s invoice for reimbursement (DFEC program only).

Please click this link to visit the OWCP Fee Schedule page for more information.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Coal Mine Workers’ Compensation (DCMWC) 1-800-638-7072
  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682
  • Division of Federal Employees' Compensation (DFEC) 1-844-493-1966
OWCP DEEOIC DME and Rehab Authorization Improvement - 09-23-2022

Effective October 1, 2022, DEEOIC will implement process improvements for submitting Durable Medical Equipment (DME) and for Rehabilitative Therapies (Rehab) authorization requests.

Improvements include:

  • Providers will be able to submit corrections to approved Rehab request authorizations.
  • Providers will be able to view the line status of an Authorization Request, including the new status of “Processed - Awaiting Decision” when the authorization line is under DEEOIC review. The status will be updated when a decision has been made by DEEOIC.

Please note that if any changes are necessary for DME authorization, then the provider can submit a new Authorization Request.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682
Important Notice Concerning Coverage of Lung Transplants by the Federal Black Lung Program - 09-14-2022

The Division of Coal Mine Workers' Compensation, or Federal Black Lung Program, requires prior approval of the pre-transplant evaluation for lung transplants and the lung transplant itself for Black Lung beneficiaries (20 C.F.R. § 725.705).

Information about an individual's general eligibility for medical benefits may be obtained by calling the District Office where the patient's claim file is located, or by calling the Black Lung toll-free number at (800) 638-7072. Eligibility for medical benefits does not automatically include approval for a pre-transplant evaluation or a lung transplant.

Before seeking approval for a pre-transplant evaluation or a lung transplant, a medical center must be approved as a lung transplant center by the Center for Medicare and Medicaid Services (CMS), or the request will automatically be denied. The list of approved transplant centers is available at:

https://qcor.cms.gov/default.jsp?referer=http://qcor.cms.gov/main.jsp

After reaching the homepage, select the “Resources” link on the upper right hand of the page. A pop-up window will open. Select link for “List of CMS-Approved Organ Transplant Programs”. This will open an excel spreadsheet which contains certification information for all Medicare-certified transplant programs, organized by State. Please refer to the approved lung transplant programs.

Approved lung transplant centers must determine if the patient's medical benefits are the responsibility of a coal mine operator or insurer or the Black Lung Disability Trust Fund. The patient should have this information. For a pre-transplant evaluation or transplant to be considered, it must be necessitated by the coal miner's black lung condition and directly related conditions. If the patient is covered by an insurer or coal mine operator, the company's approval must be obtained prior to a pre-transplant evaluation or transplant. Pre-transplant evaluation and transplant coverage is decided on a case-by-case basis. The Federal Black Lung Program expects coal mine operators or insurers to provide the same coverage that it does. The documentation that coal mine operators or insurers require to determine whether or not they will approve coverage may vary.

If the patient is covered by the Black Lung Disability Trust Fund, the approval process must be initiated by emailing the request to https://owcpmed.dol.gov or by calling the toll-free number (800) 638-7072.

Requests for pre-transplant evaluations and lung transplants should include basic information including the patient's name and date of birth, as well as the name of the facility performing the evaluation or transplant.

Additionally, a request for a pre-transplant evaluation must include a physician's letter of justification. A physician's letter of medical justification is a well-rationalized narrative statement, prepared by a qualified physician who has been actively treating the patient for their pulmonary condition. The letter of medical justification represents the physician's independent assessment and opinion and must include a brief review of the claimant's pertinent medical history, a brief statement regarding the claimant's current medical condition, and explanation of the claimant's medical need for a lung transplant evaluation.

Requests for lung transplants must include the medical facility's lung transplant protocols and all medical records produced for the pre-transplant evaluation, including the results of all tests, consultations, and narrative reports.

After the Federal Black Lung Program evaluates the information submitted, it will notify the requestor of a determination regarding coverage. Any pre-transplant evaluation or transplant performed prior to receiving prior approval by the Federal Black Lung Program will be denied.

Any questions about pre-transplant evaluations or transplants should be directed to the Division of Coal Mine Workers' Compensation at efax-maos-transplant@dol.gov or by calling the toll-free number (800) 347-2502.