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Office of Workers' Compensation Programs

Medical Bill Processing Portal

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  2. Forms & References
  3. DEEOIC

Forms and References

General
DCMWC
DEEOIC
DFEC
DLHWC

DEEOIC Forms and References

A Message to Medical Providers: Hardcopy bills and documents require a team of individuals to physically report to our mailroom facility to open, scan, and transmit these documents to our bill processor for payment. These steps, under the current conditions of the pandemic, may cause delays in processing. To avoid any delay, OWCP is asking that medical providers submit medical bills/attachments, authorizations, and non-bill documents electronically. Providers will experience much faster processing times with electronic submissions and our online notification of any bill errors further reduce processing time.

If you need assistance with submitting electronically, please call:

  • DEEOIC:  1-866-272-2682

      Select Option 2 (for Provider) and then select 3.

Provider Bills

Health Insurance Claim Form (OWCP-1500)

Uniform Health Insurance Claim Form (OWCP-04)

ADA Dental Claim Form

 

Authorization Forms

Form EE-22 – General Medical Authorization Request

Form EE-24 – Durable Medical Equipment Authorization Request

Form EE-26 – Rehabilitative Therapies Authorization Request

Form EE-28 – Transportation Authorization Request

Form EE-30 – Transplant Authorization Request

Form EE-32 – Home Health Care Authorization Request

Visit the following websites for additional information on OWCP programs:

DOL | OWCP | DCMWC | DEEOIC | DFEC | DLHWC

U.S. Department of Labor | 200 Constitution Ave NW, Washington, DC 20210
Telephone: 1-866-4-USA-DOL (1-866-487-2365) | TTY | Contact Us

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