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- 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.
 

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.

DCMWC Announcement: Modernizing Payment of Medical Benefits - 04-06-2020

Notice of Final Rule
The Office of Workers' Compensation Programs has issued a Final Rule governing the Black Lung Disability Trust Fund's payment of medical benefits under the Black Lung Benefits Act. The Final Rule:

  1. Adopts modern payment formulas for physicians, hospitals and other providers that are derived from the formulas used in the Medicare program. These formulas are also similar to those used by other OWCP programs (e.g., Federal Employees Compensation and Energy Employees Occupational Illness Compensation programs).
  2. Codifies the black lung program's current practices for the payment of prescription drugs and the submission of medical bills for payment.
  3. Provides greater clarity about fees paid to providers, which should speed processing and payment of benefits as well as make it easier for the Trust Fund to obtain reimbursement from coal companies.
  4. Prohibits providers from seeking additional payments from miners for covered services that have been paid by the Trust Fund.

Miners will not see any change in the medical care they receive to treat their black lung disease.
The regulations will be effective August 31, 2018. The rules will apply to medical equipment, prescription drugs, and inpatient medical services provided or rendered after that date. The rules governing payment of professional medical services and outpatient medical services have a delayed application date and will apply to services rendered after April 27, 2020.

The Final Rule is available for public inspection today on the Federal Register's website at: https://www.federalregister.gov/documents/2018/06/14/2018-12418/black-lung-benefits-act-medical-benefit-payments. The Federal Register published the rule on June 14, 2018. The published version is available online at the same website location.

DCMWC Announcement: Final Rulemaking on Medical Benefit Payments - 04-05-2020

On June 14, 2018, the Office of Workers' Compensation Programs Division of Coal Mine Workers' Compensation issued a final rule governing the Black Lung Disability Trust Fund's payment of medical benefits under the Black Lung Benefits Act. The revised regulations became effective on August 31, 2018. Most of them, including those governing payments for medical equipment, prescription drugs, and inpatient medical services, applied immediately. However, the regulations governing payment of professional medical services and outpatient medical services had a later applicability date of November 30, 2019, so that a new computer system could be developed to process these bills. OWCP is delaying the applicability date of the regulations governing payments for professional medical services and hospital outpatient services from November 30, 2019, to April 26, 2020, due to unforeseen delays in developing the computer system. More information is available at: https://www.dol.gov/owcp/dcmwc/