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US Department of Labor
OFFICE OF WORKERS' COMPENSATION PROGRAMS

OFFICE OF WORKERS' COMPENSATION PROGRAMS

MEDICAL BILL PROCESSING PORTAL

MEDICAL BILL PROCESSING PORTAL

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  2. Forms & References

Forms and References

General
DCMWC
DEEOIC
DFEC

General Administrative Forms & References

Note: For program specific forms, please click the respective program link above.

Claimant Reimbursement

Claimant Medical Reimbursement (OWCP-915)

Medical Travel Refund Request (OWCP-957)

 

Miscellaneous Templates

**Opening the following PDFs requires Adobe Reader.**
Adjustment Request

Fee Schedule Appeal

Carrier Reimbursement

 

Other References

837 Companion Guide

835 Companion Guide

277CA Companion Guide

Remittance Voucher Guide (updated 05/23/23)

Provider Enrollment

Provider Enrollment Application (OWCP-1168)

EDI Enrollment Template (For Billing Agent/Clearinghouse Only)

ACH Form

 

Supporting Document Cover Sheet

How to view PDFs using Adobe Reader

**Opening the following PDFs requires Adobe Reader.**
Provider Enrollment Cover Sheet

Authorization Cover Sheet

Bills Cover Sheet

 

United States Department of Labor

Office of Workers'
Compensation Programs

An agency within the U.S.
Department of Labor

200 Constitution Ave NW
Washington, DC 2021

CONTACT US

DFEC: 1-844-493-1966
DEEOIC: 1-866-272-2682
DCMWC: 1-800-638-7072
OWCP Medical Bill Processing
www.dol.gov

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Forms and References

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