Note: For program specific forms including claimant reimbursement forms, please click the respective program link.
Miscellaneous Templates
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Adjustment Request
Other References
Explanation of Benefits (EOB) Reference Guide (10/22/2025): This document gives more information for common EOB denial reasons.
Provider Enrollment
Provider Enrollment Application (OWCP-1168)
EDI Enrollment Template (For Billing Agent/Clearinghouse Only)
Supporting Document Cover Sheet
How to view PDFs using Adobe Reader
**Opening the following PDFs requires Adobe Reader.**
Provider Enrollment Cover Sheet