Announcement of DEEOIC and DCMWC Pharmacy Benefit Program

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®:

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 Virtual Help Session

OWCP will host a virtual help session on Friday July 7th 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. Please see the News section for further information

CNSI Name Change

CNSI is now Acentra Health. While our name has changed, our commitment to OWCP providers, claimants, and representatives remains the same. As you continue to interact with OWCP through the Workers’ Compensation Medical Bill Processing system and services, you will see branding updates over the next few weeks. However, rest assured that there will be no impacts to any services currently offered which includes, bill processing and prior authorization. Please continue to follow existing processes for claims submissions for reimbursement and prior authorization requests for medical services.

OWCP Virtual Help Session

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.

DEEOIC DME Supplies and Accessories Updates

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

OWCP Bill Processing Improvement

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
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