DFEC Forms and References
A Message to Medical Providers: Providers will experience faster processing timeframes with electronic submissions, and our online notification of submission errors help further reduce processing times. Hardcopy bills and documents require a team of individuals to open, scan, and transmit these documents to our bill processor for payment. To avoid any delay, OWCP is asking that medical providers submit medical bills/attachments, authorizations, and non-bill documents electronically.
If you need assistance with submitting electronically, please call:
- DFEC: 1-844-493-1966
Claimant Reimbursement
Claimant Medical Reimbursement (OWCP-915)
Medical Travel Refund Request - Mileage (OWCP-957A)
Medical Travel Refund Request - Expenses (OWCP-957B)
Provider Bills
Health Insurance Claim Form (OWCP-1500)
Uniform Health Insurance Claim Form (OWCP-04)
FECA WCMBP Payments Calendar 2024
Authorization Templates
Medical Authorization - Durable Medical Equipment
Medical Authorization - General Medical
Medical Authorization - Physical Therapy/Occupational Therapy
Medical Authorization - Transportation and Travel
Medical Authorization - HCPCS J-Code Unspecified/Unclassified