WCMBP Outage
The WCMBP System will be unavailable for maintenance on 06/02/2024 between 09:00 AM to 07:30 PM EST. We appreciate your patience while this activity occurs.
The Workers’ Compensation Medical Bill Processing (WCMBP) Call Center will be closed on Monday November 11, 2024, in observance of Veteran's Day. Please use the self-service functions offered via the Interactive Voice Response system (IVR) or the WCMBP Web Portal. The Call Center will reopen on Tuesday November 12, 2024.
The WCMBP System will be unavailable for maintenance on 06/02/2024 between 09:00 AM to 07:30 PM EST. We appreciate your patience while this activity occurs.
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Effective October 26, 2024, the Office of Workers’ Compensation Programs (OWCP) will implement new utilization review to assign limits for specific services.
This utilization review will apply to three OWCP Programs: FECA (DFEC), DCMWC, DEEOIC.
New limits have been defined for the following services:
EOB Number | EOB Description | Applicable Procedure Codes | Utilization Review |
---|---|---|---|
80429 | Coverage/program guidelines were exceeded: Exceeds number/frequency approved/allowed within the time period. | 99490, 99491, 99487, 99474, 99454, 99091, 99457 | Procedures are limited to 1 unit per 30 days. |
80430 | Lifetime benefit maximum has been reached: This service is paid only once in a patient’s lifetime. | 99473, 99453 | Blood pressure and physiological monitoring device limited to 1 per lifetime. |
80431 | Coverage/program guidelines were exceeded: Exceeds number/frequency approved/allowed within the time period. | L0140 | Cervical collar limited to 2 units per 365 days. |
For questions, contact our Call Center at the applicable phone number listed below, where a representative will be happy to assist you.
Effective August 24, 2024, providers will be required to submit billing NPI when billing for services provided to injured or ill workers for the Office of Workers’ Compensation Programs (OWCP). Professional and institutional bills submitted without the billing NPI after August 24,2024 will be denied.
Note: Providers are strongly encouraged to submit the billing taxonomy.
Billing NPI is not required for OWCP bills submitted from providers such as non-medical vendors, fiscal intermediaries, and non-emergency transportation.
Online Bill Entry (web portal direct data entry): Refer to the Direct Data Entry Billing Tutorial for instructions and examples.
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 (DCMWC, DEEOIC, or DFEC).
Additional Reminders:
For the Health Insurance Claim Form (OWCP-1500):
For Uniform Health Insurance Claim Form (OWCP-04):
For ADA Dental Claim Forms:
EDI (HIPAA 837s): Refer to the updated 837 Companion Guide.
NPI or Taxonomy | 837 File Segment |
---|---|
NPI | Loop – 2010AA Segment – NM1 NM108: Identification Code Qualifier = XX (REQUIRED) NM109: Identification Code Qualifier = NPI (REQUIRED) |
Taxonomy | Loop – 2000A Segment – PRV PRV01: BI (Billing) PRV 01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽BI✽PXC✽207Q00000X~ |
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 NM109 is required when NM108 is available Example : NM1✽82✽1✽DOE✽JANE✽C✽✽✽XX✽1234567804~ |
Taxonomy | Loop: 2310B - RENDERING PROVIDER SPECIALTY INFORMATION Segment: PRV PRV01: PE (Performing) PRV01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽PE✽PXC✽1223G0001X~ |
||
Line | NPI | Loop: 2420A — RENDERING PROVIDER NAME Segment: NM1✽82 NM108: Identification Code Qualifier = XX NM109: Identification Code Qualifier = NPI NM109 is required when NM108 is available Example: NM1✽82✽1✽DOE✽JANE✽C✽✽✽✽XX✽1234567804~ |
|
Taxonomy | Loop: 2420A — RENDERING PROVIDER SPECIALTY INFORMATION Segment: PRV PRV01: PE (Performing) PRV01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽PE✽PXC✽208D00000X~ |
||
Institutional | Header | NPI | Loop: 2310A - ATTENDING PROVIDER NAME Segment: NM1✽71 NM108: Identification Code Qualifier = XX NM109: Identification Code Qualifier = NPI NM109 is required when NM108 is available Example: NM1✽71✽1✽JONES✽JOHN✽✽✽✽XX✽1234567891~ |
Taxonomy | Loop: 2310A - ATTENDING PROVIDER SPECIALTY INFORMATION Segment: PRV PRV01: AT (Attending) PRV01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽AT✽PXC✽208D00000X~ |
Messaging will appear on your remittance voucher to alert you of any NPI or taxonomy information that is missing or does not match your provider file.
For questions, contact our Call Center at the applicable phone number listed below, where a 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