Can I submit EDI bills with the SSN or is a case number always required?
Yes, providers may submit electronic bills with either an OWCP Case Number or Social Security Number (SSN) in Loop 2010BA for segment NM109. An SSN is acceptable for a DFEC injured worker when it is submitted with Date of Injury (DOI) to identify correct case number.
Note: The SSN must be numeric only and cannot include hyphens.
Do I have to use a specific clearinghouse or billing agent when submitting EDI bills to OWCP?
No, there is not a requirement to utilize services from any specific clearinghouse or billing agent. Providers have used an "in house" or internal solution if HIPAA 837 transactions are already set up within their organization.
Note: If the clearinghouse or billing agent will be used to bill, then the clearinghouse or billing agent must be enrolled with OWCP to receive 835 response files.
EDI Enrollment Template (For Billing Agent/Clearinghouse Only)
After I enroll as a provider with OWCP, how soon can my clearinghouse submit EDI bills?
EDI billing is available as soon as the OWCP provider account(s) for both the medical provider and clearinghouse are active. The test environment is available, but completion of the testing process is not mandatory prior to submitting electronic transactions to WCMBP. However, testing is strongly recommended to ensure proper billing and prompt medical bill processing and payment. Refer to the 837 Companion Guide for more details.
On the Direct Data Entry (DDE) online billing page, I keyed in my bill information but did not see the option to upload attachments or submit the bill. What should I do?
Your web browser's pop-up blocker may be preventing the browser window from opening. Be sure to update the permissions on your web browsers to allow the browser window to open.
How can I avoid delays for processing of medical bills?
All providers are encouraged to submit authorization requests using direct data entry. By using the WCMBP Provider Portal, the provider can instantly confirm if an authorization is required. If an authorization is required, the request review process starts immediately at submission.
Does WCMBP have an electronic payer ID for each program?
The electronic payer ID’s are:
- DFEC: 77044
- DEEOIC: 77103
- DCMWC: 77104
I have received emails to an email address that I no longer use for billing services. How do I update my contact information, including my email address?
Provider profile can be updated by logging into the WCMBP Provider Portal.
What is OWCP Connect?
OWCP Connect registration is necessary before accessing the WCMBP Provider Portal. To register for OWCP Connect, visit https://owcpconnect.dol.gov/owcplogin/RegPIInputServlet
I am a DFEC provider. Do I need to submit an authorization request for telehealth services?
Authorization requirements for DFEC telehealth bills are dependent on Provider Type and the Procedure Codes. If authorization is required, your bills must be submitted with the necessary modifiers. Please utilize the WCMBP Provider Portal for eligibility and authorization requirements. See the DFEC bulletin https://www.dol.gov/agencies/owcp/dfec/regs/compliance/DFECfolio/FECABulletins/FY2020-2024 for more information. Go to this page on the portal for the DFEC Forms and References and select Medical Authorization - General Medical from the Authorization Templates list.
I received notification that my provider license will be expiring soon. What do I need to do to update my information?
Providers have 30 calendar days from the time of receiving notification to update your information. Please update your license/certification information using the WCMBP Provider Portal. For any questions regarding updating provider information, please contact the call center.
- Division of Energy Employees' Occupational Illness Compensation (DEEOIC) Program: 1-866-272-2682
- Division of Federal Employees' Compensation (DFEC) Program: 1-844-493-1966
- Division of Coal Mine Workers' Compensation (DCMWC) Program: 1-800-638-7072
What should I do if my enrollment application was “returned to provider” (RTP)?
Providers are encouraged to submit their application using the WCMBP Provider Portal. If the provider has an application number, they may update the RTP'ed information directly in the WCMBP Provider Portal for immediate processing. Alternately, the provider may mail or fax the modified application. Please refer to the Quick Reference Guide, Provider Enrollment eLearning, or Provider Enrollment Tutorials for detailed step-by-step instructions.
What do I need to do if my provider licensed has expired?
If a provider license has expired, the account must be reinstated the account using the WCMBP Provider Portal. Please note that upon reinstatement of the account OWCP Provider ID will remain the same. For step by step instructions, please refer to the Reference Guides Section: Updating Provider License in the Provider Portal.
I can see bills up to 7 years old in the WCMBP system. How can I get access to see bills older than 7 years?
Bill history data is archived after 7 years from the date the bill was paid. Please contact the call center for access to any archived bill data. You will need to provide a Claimant ID, Date of Service, and OWCP Provider ID. The requested bill data will be provided within five business days.
Where do I find the new authorization templates/forms?
The new authorization templates/forms can be found at https://owcpmed.dol.gov/portal/resources/forms-and-references/general. Select the respective program in the dark gray bar on that page, and click the link of the authorization type that you want to submit.
Do I have to be registered to access the forms on the portal?
There is no registration needed to access the authorization templates. The new authorization templates are available at: https://owcpmed.dol.gov/portal/resources/forms-and-references/general.
How do I submit an authorization request?
Authorization requests may be submitted via Direct Data Entry using the WCMBP Provider Portal, or by Fax at: 1-800-215-4901 (DFEC) or 1-800-882-6147 (DEEOIC). Direct Data Entry is the recommended method as it provides real time editing and speeds the overall authorization process.
How do I modify my Provider Type?
Provider Type changes are completed by updating provider information in the WCMBP Provider Portal and submitting supporting license. To access the WCMBP Provider Portal, click here.
When enrolling, how do I submit the licenses for Group Providers and Individual Providers?
Individual Providers should submit their individual license in Step 5.
For Group Providers, provide business license in Step 5 and individual provider license in Step 10.
Do body part modifiers on Authorizations have to match the body part modifier on the bill?
Body part modifiers do not impact authorizations from being applied to bill service lines. Procedure code modifiers must match in order for the authorization to be applied to the bill.
If my state does not require a license, how can I proceed with enrollment?
Please indicate in the comments field in Step 5, “No license required”. You will also need to submit proof that your state does not require a license.
Where should I enter my Provider ID in the CMS-1500 form?
The Provider ID is entered in box 33.
Does the Diagnosis code on the Authorization have to match the Bill?
The diagnosis code on the Authorization does not need to match the diagnosis code of the bill service line.
Can I bill for an office visit during the global surgery period if the office visit Is unrelated to the surgery?
A correction will not be needed as Surgical Packages do not require modifiers.
Please refer to the global surgery guidelines
Where can I receive more information regarding withheld payments?
Please contact the Internal Revenue System (IRS).
What are timely filing rules for submitting bills?
Timely filing is the end of the year following the DOS or one year from case acceptance.
What type of bills price are priced using DRG (Diagnostic-Related Groups)?
DRG pricing only applies to inpatient bills submitted by acute hospitals (provider type 01) and the type of bill will fall within the range of 111–117.