DFELHWC Pharmacy Paper Bills - 04-06-2021

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

OWCP ANNOUNCEMENT- OPTUM/FECA PHARMACY BENEFIT PROGRAM IS MANDATORY FOR ALL FECA CLAIMANTS - 03-11-2021

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 tmesys.network@optum.com.

New Telemedicine Guidelines for OWCP-FECA - 11-09-2020

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.

COVID-19 Update - 04-20-2020

Due to the COVID-19 pandemic and the desire to follow social distancing, OWCP is taking steps to move toward a fully-electronic medical bill processing system. Currently, we continue to accept paper documents but providers who continue to submit paper documents may experience processing delays.

Currently-enrolled medical providers can now register for web portal accounts that enable electronic submission and the ability to modify provider profile, view status of authorization requests, and bill processing/payment.  

  • To register for web portal accounts, please reference the Welcome Letter and the Registration Letter mailed to you from CNSI on April 17, 2020. Use the Temporary ID and Temporary Key provided to login in to your account.

  • Webinars and companion guides are provided on the web portal with instructions on submitting bills electronically.

Hardcopy Bill/Attachments Processing To avoid processing delays, OWCP is asking medical providers to submit medical bills/attachments electronically.

Hardcopy bills and documents require a team of individuals to physically report to our mailroom facility to open, scan, and transmit these documents to our bill processor for payment. These steps, under the current conditions of the pandemic, may cause delays in processing and payment of hardcopy bills. To avoid any delay, OWCP is asking that medical providers submit medical bills/attachments electronically. Providers will experience much faster processing times with electronic submissions and our online notification of any bill errors further reduces processing time.

  • Please refer to the Quick Guide on how to submit bills/attachments electronically.
Hardcopy Non-Bill Documents (such as medical reports) To avoid processing delays, providers should submit all non-bill documents electronically via the program web portals.

Hardcopy non-bill documents (such as medical reports) require a team of individuals to physically report to our mailroom facility to open, scan, and transmit these documents. These steps, under the current conditions of the pandemic, may cause delays in processing. To avoid processing delays, providers should submit all non-bill documents electronically via the following program web portal:

Providers submitting bills/attachments via direct data entry (DDE) and secured batch (SFTP) can include the attachments with the bill transmission.

Authorization Requests (New Templates) For faster processing, please submit all authorization requests online.

Providers should submit all authorization requests online. Should providers need assistance in submitting authorization requests, please contact:

  • DFEC:      1-844-493-1966
  • DCMWC:  1-800-638-7072
  • DEEOIC:  1-866-272-2682

      Select Option 2 (for Provider) and then select 2 (for Authorizations).

The new authorization templates can be found here:

Provider Enrollment New medical providers should submit enrollment applications online.

New medical providers should submit enrollment applications online. Should providers need assistance in submitting online applications, please contact:

  • DFEC:      1-844-493-1966
  • DCMWC:  1-800-638-7072
  • DEEOIC:  1-866-272-2682

      Select Option 2 (for Provider) and then select 3 (for Enrollment).

DEEOIC Web Portal Announcement - Target Case Management for Home Health Care - 04-16-2020

Effective April 25, 2019, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) released a new policy regarding Targeted Case Management (TCM). TCM authorization requests submitted prior to April 25, 2019, are not impacted by the new policy.

Targeted Case Management (TCM) can occur when a claimant is prescribed multiple types or levels of care related to their covered condition(s). TCM is the coordination of different care providers (such a Home Health Aids, RNs, Therapists, etc.), and the different treatments being provided to assure that the medical care is appropriately scheduled, and that treatments don't inappropriately overlap or have unintended negative impacts on the claimant's health. This process facilitates services provided and assists claimants in gaining access to needed medical, social, educational, and other services directly related to their DEEOIC accepted condition(s).

DEEOIC does not reimburse for the supervision and monitoring of staff by RNs or other higher credentialed individuals. DEEOIC considers the supervision of home health care staff to be the inherent responsibility of the medical provider that the claimant chooses to provide health care services. The training or continuing education of health care personnel is also not considered TCM or reimbursed.

See the EEOICPA circular on Targeted Case Management for Home Health Care.

DEEOIC- Initial Home Health Care, Nursing Home or Assisted Living Request forms: EE-17A and EE-17B - 04-16-2020

A regulatory change to the EEOICPA Final Rule was published on February 8, 2019, and went into effect April 9, 2019. This change made OMB forms EE-17A and EE-17B required for initiating initial (claimant has never received services through EEOICPA) authorization requests for home health care, hospice, assisted living, and nursing home care. Upon implementation of the forms on June 3, 2019, medical providers will no longer submit authorization request forms to Conduent to initiate care for the aforementioned service types when the claimant requests care for the first time. However, the authorization details (approved, denied, or pending) concerning these requests will continue to be processed and transmitted to Conduent. All emergency temporary authorization requests, or requests for reauthorization, or requests for an amended level of care will continue to be submitted to Conduent using the existing processes.

Review the EE-17A and EE-17B forms.