OWCP adjustment/void processing for DFEC and DCMWC - 05-31-2024

Effective June 1, 2024, the Office of Workers’ Compensation Programs (OWCP) will implement updates for adjustment/void processing.

For the Division of Federal Employees’ Compensation (DFEC), providers will no longer be allowed to submit bill void transactions.

For the Division of Coal Mine Workers’ Compensation (DCMWC), providers will have the new option to submit bill adjustments using the WCMBP portal.

For the Division of Energy Employees Occupational Illness Compensation (DEEOIC), there are no changes in the current process for adjustment requests.

For questions, contact our Call Center at the applicable phone 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 DFEC Recoupment Process - 04-15-2024

Effective April 20, 2024, the Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees’ Compensation (DFEC) will implement a recoupment process for providers’ outstanding debts.

Providers may have partial or full payment amounts applied to existing overpayments until the full overpaid amount is satisfied and all debts are closed.

Providers can refer to the remittance voucher (RV) for overpayment summary, recoupment summary, and recoupment details. A Remittance Voucher User Guide is available for an explanation on how to read the sections in the RV.

In addition, providers can also use the View Accounts Receivable feature after logging in to the Workers’ Compensation Medical Bill Processing (WCMBP) portal OWCP Connect (dol.gov). Providers can filter or sort results on the Accounts Receivable (AR) List to identify overpayment history, verify remaining debt balance owed, and review accounts receivable details by clicking on the AR Number.

Annual 1099s balances will be updated to reflect all recoupments.

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

OWCP DFEC Bill Processing Improvement for Newly Accepted Cases - 12-06-2023

Effective December 9, 2023, the DFEC Program for Office of Workers’ Compensation Programs (OWCP) will enhance bill processing to automatically reprocess previously submitted bills that denied when the injured or ill worker’s case was under development, after the case is later accepted as payable by OWCP.

On December 9, 2023, a one-time courtesy bill reprocessing will occur for claimant cases that were adjudicated by DFEC, and accepted conditions assigned in the previous four weeks.

Afterwards, bills denied after December 9, 2023, will be automatically reprocessed if the case is accepted as payable.

Please note that additional denial EOBs may post during reprocessing. For example, if denials post for authorization of services related to accepted conditions, then providers are encouraged to request authorization for the billed service(s).

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 Federal Employees' Compensation (DFEC):
    1-844-493-1966
DFEC Hearing Aid Supplies and Services Utilization Review - 07-17-2023

Effective July 15, 2023, the Office of Workers’ Compensation (OWCP) Division of Federal Employees’ Compensation (DFEC) Program is implementing a new utilization review (UR) for hearing aid services and supplies.

Please refer to the FECA Circular NO. 23-08 for more information. FECA Circulars | U.S. Department of Labor (dol.gov)

New limits have been defined for DFEC hearing aid supplies and services.

EOB Number EOB Description Applicable Procedure Codes
81021 BATTERY FOR HEARING DEVICE LIMITED TO 30 UNITS PER 180 DAYS V5266
80151 HEARING AID SERVICES ARE LIMITED TO 1 PER 730 DAYS V5264, V5265, V5275
80152 HEARING AID SERVICES ARE LIMITED TO 1 PER 1825 DAYS V5010, V5020, V5030, V5040, V5050, V5060, V5070, V5080, V5090, V5100, V5110, V5120, V5130, V5140, V5150, V5160, V5170, V5171, V5172, V5180, V5181, V5190, V5200, V5210, V5211, V5212, V5213, V5214, V5215, V5220, V5221, V5230, V5240, V5241, V5242, V5243, V5244, V5245, V5246, V5247, V5248, V5249, V5250, V5251, V5252, V5253, V5254, V5255, V5256, V5257, V5258, V5259, V5260, V5261, V5262, V5263, V5267, V5268, V5269, V5270, V5271, V5272, V5273, V5281, V5282, V5283, V5284, V5285, V5286, V5287, V5288, V5289, V5290, V5298
81019 HEARING AID REPAIR/SUPPLY LIMITED TO 3 UNITS PER 1825 DAYS V5014
81061 HEARING AID FITTING/CHECKING LIMITED TO 4 PER 1825 DAYS V5011

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 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

DFEC Psychological Exams and Evaluations Utilization Review (UR) - 08-22-2022

Effective August 20, 2022, the DFEC program will be implementing new utilization review (UR) for psychological exam and evaluation procedure codes. This change will impact professional, outpatient, and prompt pay bills.

Please refer to the DFEC Bulletin at this link for more information.

You may also 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 Updates to DFEC Surgical Package Authorization and Bill Processing - 07-01-2022

As of July 9, 2022, OWCP will implement enhancements to Surgical Package Authorization and Bill Processing for DFEC. Updates will be made to better reflect the providers involved in providing the surgical procedure.

Enhancements will include:

  • Adding new Professional Type for Co-Surgeon for both online and paper authorization requests
  • Allowing the same surgical package authorization request to cover all Professional Types
  • Enhancing the authorization utilization and bill history screen to include Professional Type

You may also contact our Call Center at the number(s) listed below where a Call Center representative will be happy to assist you.

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

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.