The Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) requires that valid surgical procedure codes be submitted for surgical package authorization requests. The valid surgical code range is 10021 – 69990.
Non-surgical procedure codes cannot be submitted on a surgical package authorization request. Mailed or faxed surgical package authorization requests submitted with non-surgical procedure codes will be returned to the provider (RTP’d).
Non-surgical procedure codes can be submitted on an alternative authorization request template, such as General Medical. Please see our Authorizations Introduction page for templates and tutorials: https://owcpmed.dol.gov/portal/Provider/Authorizations.
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
Effective July 13, 2024, the Office of Workers’ Compensation Programs (OWCP) will enhance the Workers’ Compensation Medical Bill Processing (WCMBP) eligibility inquiry and authorization submission pages with new messaging to inform users if the procedure code is covered or not covered with a certain modifier.
The eligibility inquiry messaging is applicable to the DCMWC, DEEOIC, and DFEC programs.
The authorization submission messaging is applicable to DEEOIC and DFEC.
The message will be updated to include the following scenarios:
- Procedure code and modifier combination is not covered.
- Procedure code must be submitted with modifier to be covered.
- Procedure code/modifier combination are not covered, but procedure code and other modifier combination are covered.
For additional information, contact our Call Center at the applicable numbers 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
The Division of Energy Employees Occupational Illness Compensation (DEEOIC) does not accept payments made by mail. All providers must submit an adjustment (corrected bill) to ensure that the overpayment created is properly reflected as an account receivable by DEEOIC. Once the account receivable is established, providers will receive a debt letter and instructions on how to service the account receivable from the Treasury's Centralized Receivables Service (CRS). For more information click here and refer to the section titled "How to Submit Refunds of Overpayments".
Beginning June 1, 2024, Office of Workers’ Compensation Programs (OWCP) providers can access a new Electronic Case Lookup feature on the secure Workers’ Compensation Medical Bill Processing (WCMBP) portal.
Providers will be able to enter claimant information to obtain a claimant’s OWCP case number. This feature will be available to locate the case number for DCMWC, DEEOIC, or DFEC claimants.
After selecting the Program, providers will be able to inquire by:
- Date of Birth (DOB) and Social Security Number (SSN) or
- Date of Birth (DOB), First Name, and Last Name
- Please note, in addition to the above criteria, providers must enter the Date of Injury (DOI) for DFEC claimants.
Please refer to the Verify Claimant Eligibility tutorial for further information.
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
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.
- Providers wishing to return funds have the option to mail the refund along with an Adjustment Request template as the coversheet.
- For assistance in viewing the PDF, please select this link: How to view PDFs using Adobe Reader
For the Division of Coal Mine Workers’ Compensation (DCMWC), providers will have the new option to submit bill adjustments using the WCMBP portal.
- You may refer to the Bill Adjustment tutorial for further information.
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
Effective June 1, 2024, the Office of Workers’ Compensation Programs (OWCP) will implement an enhancement to prevent overpayments created from denied adjustment requests.
On or after June 1, 2024, if an adjustment is submitted on a bill that has already been paid but subsequently denied in its entirety, the denial will be reflected on the Remittance Advice (RV), and the bill inquiry screen will display a status of denied.
In such cases, when providers seek payment reconsideration for the denied bill, it is essential to submit the adjustment request using the previously paid bill. This ensures that the adjustment is correctly associated with the original bill and facilitates the review process for payment reconsideration.
Providers are encouraged to use the Bill Inquiry and Bill Adjustment features of the Workers’ Compensation Medical Bill Processing (WCMBP) Portal https://owcpmed.dol.gov/ to review bill history.
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
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
Effective April 20, 2024, OWCP will release a new Fee Schedule Calculator tool on the Workers’ Compensation Medical Bill Processing (WCMBP) web portal https://owcpmed.dol.gov/portal/. This feature will be available to providers after logging in to the secure WCMBP portal.
The fee schedule calculator is a tool used to estimate the maximum allowable amount for services rendered and billed on the OWCP 1500 Professional form or the ADA Dental form. It is important to note:
- While the fee schedule calculator tool estimates payment, it does not guarantee eligibility or coverage for your specific service.
- The fee schedule calculator tool will not advise if services are appropriate for the accepted condition and will not confirm if authorization is required. Please use the Claimant Eligibility Inquiry and Authorization Submission features to verify this information.
Please refer to the Fee Schedule Calculator Quick Reference Guide for step-by-step instructions.
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 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 April 20, 2024, providers can select an option to receive outbound OWCP medical bill processing correspondence electronically only. Electronic copies can be accessed on the secure WCMBP Portal (https://owcpmed.dol.gov/portal/).
The paperless option includes correspondence such as Remittance Vouchers (RV), Authorization Approval Letters, and Billing Returned To Provider (RTP) Letters.
Providers can select the paperless option in the Add Location step of a provider enrollment application or the Provider Maintenance page by selecting the “opt in” checkbox. A contact email address will be required, as providers will receive an email notification notifying that correspondence is available on the WCMBP Portal
Provider Enrollment and IRS correspondence will continue to be mailed in addition to being available electronically on the portal. This includes 1099s, Provider Enrollment Welcome Packets, and Provider Enrollment RTPs.
For additional information, 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
The U.S. Department of Labor (DOL) has contracted with Conduent to provide pharmacy billing 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 a new Medical Benefit Identification Card (MBIC). If you are a DEEOIC or DCMWC claimant and still need a new MBIC, please contact the Acentra Health Customer Service toll-free number at 1-800-638-7072 for DCMWC or at 1-866-272-2682 for DEEOIC.
Pharmacies are required to submit their pharmacy transactions electronically to Conduent for payment. Pharmacies are encouraged to call Conduent at 1-866-664-5581 for prescription benefit and processing assistance.
If you are a DEEOIC or DCMWC claimant, you will be receiving a new benefits card in the mail in March 2024 with associated documents from Acentra Health on behalf of OWCP. Your current card will remain active until March 15, 2024. If you do not receive your card by March 15, 2024, please call Acentra Health Customer Service toll-free number for DCMWC at 1-800-638-7072 or DEEOIC at 1-866-272-2682.
Effective January 27, 2024, providers can submit provider enrollment applications and enrollment maintenance updates using an electronic signature.
An electronic signature will be applied to the application based on the account information of the user who is completing the application online. A “wet” or physical signature will no longer be required to submit an enrollment application or update.
Electronic signatures are also applicable in these scenarios:
- Online provider enrollment application with the status of “In Progress” (started but not submitted).
- Online provider enrollment application with status of “Returned to Provider” (RTP’d).
Please refer to the Enrollment Resource Guides for further information by visiting https://owcpmed.dol.gov/portal/Provider/Enrollments.
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 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 December 9, 2023, the DEEOIC and DFEC Programs for the Office of Workers’ Compensation Programs (OWCP) are implementing an enhancement to allow providers to cancel an authorization request. Specifically, this cancel option will be available for initial and correction authorization requests with an “In Review” or “Processed Awaiting Decision” status.
For additional information, please contact our Call Center at the number listed below. 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
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
In an ongoing effort to better align with industry standards of practice, the Office of Workers’ Compensation Programs (OWCP) is enhancing its medical bill processing system to capture the provider NPI and taxonomy number for billing and servicing providers. Providers are encouraged to include NPI and taxonomy number when billing for services provided to injured or ill workers for the Office of Workers’ Compensation Programs.
Online Bill Entry (web portal direct data entry):
Refer to the Direct Data Entry Billing Tutorial for instructions and examples.
- Web portal fields will be added for providers to include billing and rendering (servicing) NPI and taxonomy.
- Be sure to note that for all claim types, the billing NPI will be added to your bill based on your OWCP provider record. You may update the billing NPI on your bill prior to submitting.
Note: If the wrong billing NPI populates on your bill, please be sure to submit a provider enrollment update with the correct NPI information. For step-by-step instructions, refer to the quick reference guide Updating Provider Information in the Provider Portal - Messaging may appear on the portal to ensure NPI and taxonomy are both entered
Mail (paper form):
Refer to the billing instructions for each claim form by visiting the OWCP Forms and References page and selecting the OWCP Program (DCWMC, DEEOIC, or DFEC).
Health Insurance Claim Form (OWCP-1500):
- Billing provider NPI is to be entered in Box 33a and billing taxonomy is to be entered in Box 33b
Note: If you have been submitting your 9-digit billing OWCP provider ID using Box 33b, please begin entering your OWCP provider ID in Box 33 per the form instructions. - Rendering (servicing) taxonomy and rendering (servicing) NPI are to be entered in Box 24J
For Uniform Health Insurance Claim Form (OWCP-04):
- Billing provider NPI is to be entered in Box 56 and billing taxonomy is to be entered in Box 81CCa
- Attending (servicing) NPI is to be entered in Box 76 and attending taxonomy is to be entered in Box 81CCb
For ADA Dental Claim Forms:
- Billing provider NPI is to be entered in Box 49 and billing taxonomy is to be entered in Box 52a
- Treating (servicing) NPI is to be entered in Box 54 and servicing taxonomy is to be entered in Box 56a
EDI (HIPAA 837s): Refer to the updated 837 Companion Guide.
- 837 file segment details for billing provider NPI and taxonomy
NPI or Taxonomy 837 File Segment NPI Loop – 2010AA
Segment – NM1
NM108: Identification Code Qualifier = XX
NM109: NPITaxonomy Loop – 2000A Segment – PRV
PRV01: BI (Billing)
PRV02: PXC (Qualifier for taxonomy code)
PRV03: Provider taxonomy code
Example: PRV?BI?PXC?207Q00000X~ - 837 file segment details for servicing provider NPI and taxonomy PRV03: Provider taxonomy code
Claim Type Location NPI or Taxonomy 837 File Segment Professional/Dental Header NPI Loop: 2310B — RENDERING PROVIDER NAME
Segment: NM1?82
NM108: Identification Code Qualifier = XX
NM109: NPI
Example : NM1?82?1?DOE?JANE?C???XX?1234567804~Taxonomy Loop: 2310B
Segment: PRV
PRV01: PE (Performing)
PRV02: PXC (Qualifier for taxonomy code)
PRV03: Provider taxonomy code
Example: PRV?PE?PXC?1223G0001X~Line NPI Loop: 2420A — RENDERING PROVIDER NAME
Segment: NM1?82
NM108: Identification Code Qualifier = XX
NM109: NPI
Example: NM1?82?1?DOE?JANE?C????XX?1234567804~Taxonomy Loop: 2420A
Segment: PRV
PRV01: PE (Performing)
PRV02: PXC (Qualifier for taxonomy code)
PRV03: Provider taxonomy code
Example: PRV?PE?PXC?208D00000X~Institutional Header NPI Loop: 2310A - ATTENDING PROVIDER NAME
Segment: NM1?71
NM108: Identification Code Qualifier = XX
NM109: NPI
Example: NM1?71?1?JONES?JOHN????XX?1234567891~Taxonomy Loop: 2310A
Segment: PR
PRV01: AT (Attending)
PRV02: PXC (Qualifier for taxonomy code)
Example: PRVAT?PXC?208D00000X~
New messaging will appear on your remittance voucher to alert you if any of the required NPI or taxonomy information is missing or does not match your provider record. Be sure to view the Explanation of Benefits (EOB) Quick Reference Guide for further details.
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 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