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US Department of Labor
Office of Workers' Compensation Programs

Medical Bill Processing Portal

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  2. Forms & References

Forms and References

General
DCMWC
DEEOIC
DFEC
DLHWC

General Administrative Forms & 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:

  • DFEC:      1-844-493-1966
  • DCMWC:  1-800-638-7072
  • DEEOIC:  1-866-272-2682

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

 

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 User Guide

Provider Enrollment & Updates

Provider Enrollment Application (OWCP-1168)

EDI Enrollment Template (For Billing Agent/Clearinghouse Only)

ACH Form Update

 

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

 

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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