The U.S. Department of Labor (DOL) has contracted with myMatrixx®, an Express Scripts Company, to provide Pharmacy Benefit Management (PBM) services to the Office of Workers’ Compensation Programs (OWCP) Division of Energy Employees Occupational Illness Compensation (DEEOIC) and Division of Coal Mine Workers’ Compensation (DCMWC).
All DEEOIC and DCMWC claimants should now have new Medical Benefit Identification Cards (MBIC) and access to myMatrixx®’s nationwide network of participating pharmacies and durable medical equipment. If you are a DEEOIC or DCMWC claimant and still need a new MBIC, please contact the CNSI customer service toll-free number at 1-800-638-7072 for DCMWC or at 1-866-272-2682 for DEEOIC.
Claimants can search for participating pharmacies on the web or by calling myMatrixx®:
- DCMWC - https://blacklung-pharmacy.dol.gov/ or 1-877-880-9215
- DEEOIC - https://energyworkers-pharmacy.dol.gov/ or 1-866-686-9592
As of June 5, 2023, pharmacies have been required to submit their pharmacy transactions to myMatrixx® for payment. Pharmacy providers are encouraged to join the myMatrixx® network and can enroll at www.esiprovider.com.
OWCP will host Virtual Help Session on Friday July 7, 2023, from 5:00 - 6:00 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.
Effective June 24, 2023, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) will enhance the bill processing of durable medical equipment (DME) supplies and accessories.
A separate DEEOIC Durable Medical Equipment (DME) supplies and accessories authorization is not required for the following conditions:
- A rental authorization is approved and on file for the related DME, and service dates are within the rental period.
- A purchase authorization is approved and on file for the related DME, and service dates are within three (3) years of the purchase period.
Providers will not need to submit a correction to an existing DME authorization for the associated supplies or accessories if an approved authorization is on file.
| HCPCS Code | Description | Associated DME Codes |
|---|---|---|
| A4615 | A4615 Cannula, nasal | E1390, E1391, E1392 |
| A4616 | Tubing (oxygen), per foot | E1390, E1391, E1392 |
| A4620 | Variable concentration mask | E1390, E1391, E1392 |
| E0441 | Stationary oxygen contents, gaseous, one month’s supply = 1 unit | E0424, E0425 |
| E0442 | Stationary oxygen contents, liquid, one month’s supply = 1 unit | E0440 |
| E0443 | Portable oxygen contents, gaseous, one month’s supply = 1 unit | E0430, E0431 |
| E0444 | Portable oxygen contents, liquid, one month’s supply = 1 unit | E0434, E0435 |
| E0555 | Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter | E1390, E1391, E1392 |
| E1353 | Regulator | E1390, E1391, E1392 |
In addition, new utilization limits are added to restrict certain DME codes for DEEOIC.
| EOB Number - Message | Procedure Codes | Modifier |
|---|---|---|
| 80907 - DME supply of nasal cannula is limited to 500 units per 180 days | A4615 | N/A |
| 80908 - DME supply of oxygen tubing is limited to 1000 units per 180 days | A4616 | N/A |
| 80909 - DME supply of concentration mask is limited to 40 units per 180 days | A4620 | N/A |
| 80910 - DME supply of humidifier is limited to 20 units per 180 days | E0555 | N/A |
| 80911 - DME supply of regulator is limited to 10 units per 180 days | E1353 | N/A |
| 80912 - DME oxygen system rental is limited to 12 units per 366 days | E0424, E0431, E0433, E0434, E0439 | RR |
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 Energy Employees Occupational Illness Compensation (DEEOIC): 1-866-272-2682
Effective June 24, 2023, the DFEC and DEEOIC Programs for the Office of Workers’ Compensation Programs (OWCP) will enhance bill processing to prevent denials related to accepted conditions if an approved authorization is on file for the billed service.
No changes are necessary for submitting authorization requests or bills. All approved authorizations will need to match the billing OWCP Provider, OWCP Claimant, date(s) of service, and procedure code. In addition, the DEEOIC program will require the billed diagnosis code to match the authorized diagnosis code.
The following are updates specifically for the DEEOIC program:
- New EOB denial reason 90972 will post if a billed diagnosis code does not match the diagnosis code on the approved authorization.
- The following new EOB denial reason will appear on the Remittance Voucher (RV): “Matching authorization is available, but dx on bill is different from the approved authorization”
- New authorization Edit 61342 will post if an authorization is submitted with a non-payable diagnosis code.
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 Energy Employees Occupational Illness Compensation (DEEOIC): 1-866-272-2682
- Division of Federal Employees' Compensation (DFEC):1-844-493-1966
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.
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
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
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 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.
Please click here for DEEOIC FAQs regarding myMatrixx and new DEEOIC program pharmacy benefits.
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.
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
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.
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 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.
