DEEOIC Authorization Updates

Effective August 5, 2023, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) will update the guidelines for submitting the same services within an authorization request.

Providers will not be able to submit an authorization request under the following conditions:

  • The same procedure code on multiple lines, even if the dates of service are not overlapping
  • The same procedure code on multiple lines, even if submitted with a modifier
  • The same revenue center code (RCC) on multiple lines without a different procedure code or with no procedure code

Providers will be able to submit an authorization request under the following conditions:

  • The same procedure code using a date range
  • Separate dates of service under different authorization requests.

For additional information, please contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees Occupational Illness Compensation (DEEOIC): 1-866-272-2682

DEEOIC DME Supplies and Accessories Updates

Effective June 24, 2023, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) will enhance the bill processing of durable medical equipment (DME) supplies and accessories.

A separate DEEOIC Durable Medical Equipment (DME) supplies and accessories authorization is not required for the following conditions:

  • A rental authorization is approved and on file for the related DME, and service dates are within the rental period.
  • A purchase authorization is approved and on file for the related DME, and service dates are within three (3) years of the purchase period.

Providers will not need to submit a correction to an existing DME authorization for the associated supplies or accessories if an approved authorization is on file.

HCPCS Code Description Associated DME Codes
A4615 A4615 Cannula, nasal E1390, E1391, E1392
A4616 Tubing (oxygen), per foot E1390, E1391, E1392
A4620 Variable concentration mask E1390, E1391, E1392
E0441 Stationary oxygen contents, gaseous, one month’s supply = 1 unit E0424, E0425
E0442 Stationary oxygen contents, liquid, one month’s supply = 1 unit E0440
E0443 Portable oxygen contents, gaseous, one month’s supply = 1 unit E0430, E0431
E0444 Portable oxygen contents, liquid, one month’s supply = 1 unit E0434, E0435
E0555 Humidifier, durable, glass or autoclavable plastic bottle type, for use with regulator or flowmeter E1390, E1391, E1392
E1353 Regulator E1390, E1391, E1392

In addition, new utilization limits are added to restrict certain DME codes for DEEOIC.

EOB Number - Message Procedure Codes Modifier
80907 - DME supply of nasal cannula is limited to 500 units per 180 days A4615 N/A
80908 - DME supply of oxygen tubing is limited to 1000 units per 180 days A4616 N/A
80909 - DME supply of concentration mask is limited to 40 units per 180 days A4620 N/A
80910 - DME supply of humidifier is limited to 20 units per 180 days E0555 N/A
80911 - DME supply of regulator is limited to 10 units per 180 days E1353 N/A
80912 - DME oxygen system rental is limited to 12 units per 366 days E0424, E0431, E0433, E0434, E0439 RR

For additional information, please contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees Occupational Illness Compensation (DEEOIC): 1-866-272-2682

OWCP DEEOIC Authorization Improvement

Effective April 1, 2023, DEEOIC will implement process improvements for General Medical (GM), Transplant, and Transportation (Medical Travel) authorization requests.

Providers will be able to view the line status of an Authorization Request, including the new status of "Processed - Awaiting Decision," when the authorization line is under DEEOIC review. The status will be updated when a decision has been made by DEEOIC.

There is no change to the process of submitting authorization requests via the online Medical Bill Processing Portal or via the authorization request forms.

Please note that if any changes are necessary for an existing General Medical, Transplant, or Transportation authorization, the provider can submit a new Authorization Request.

For additional information, contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation
    (DEEOIC) 1-866-272-2682

OWCP DEEOIC Home Health Procedure Code Updates

Effective December 17, 2022, DEEOIC will implement an update to procedure code Authorization and Billing for Home Health (HH) services for reimbursement using hourly and 15-minute incremented procedure codes. In addition, some per-diem Home Health procedure codes will be retired.

Key impacts:

  • Providers will not be required to submit new or corrected authorization requests for authorizations submitted prior to 12/17/22 with retired codes
  • Authorization requests submitted prior to 12/17/22 with retired per-diem codes will continue to be processed.
  • Providers will be able to submit corrections to update units/amount and dates for service lines with retired procedure codes in Approved status after 12/17/22. However, providers will be unable to add new service lines to the same authorization using a retired code.
  • If the approved authorization on file contains retired code(s), Providers should use the code(s) when billing. For example, if an authorization is approved on 12/16/22 for 6 months of per-diem home health services, then the provider should continue to use the per-diem codes for billing through the end of the approved date span.
  • Providers will receive an RTP reason stating that the “Requested Procedure Code is expired or invalid” if a Home Health authorization request with retired codes is received after 12/17/22.

Please refer to DEEOIC Bulletin No.23-03 for more details.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682

OWCP DEEOIC DME and Rehab Authorization Improvement

Effective October 1, 2022, DEEOIC will implement process improvements for submitting Durable Medical Equipment (DME) and for Rehabilitative Therapies (Rehab) authorization requests.

Improvements include:

  • Providers will be able to submit corrections to approved Rehab request authorizations.
  • Providers will be able to view the line status of an Authorization Request, including the new status of “Processed - Awaiting Decision” when the authorization line is under DEEOIC review. The status will be updated when a decision has been made by DEEOIC.

Please note that if any changes are necessary for DME authorization, then the provider can submit a new Authorization Request.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682

OWCP DEEOIC Home Health Authorization Status Updates

Effective May 28, 2022, DEEOIC Home Health Requests for authorizations submitted by the provider will be combined into a single Authorization Request number to align to the authorization decisions made by the DEEOIC Program.

Additional improvements include:

  • Providers will be able to submit corrections to approved Home Health request authorizations.
  • Providers will be able to view the line status of an Authorization Request, including the new status of "Processed - Awaiting Decision" when the authorization line is under DEEOIC review. The status will be updated when a decision has been made by DEEOIC.

For additional information, you may contact our Call Center at the number listed below, where a Call Center representative will be happy to assist you.

  • Division of Energy Employees' Occupational Illness Compensation (DEEOIC) 1-866-272-2682

DEEOIC- Initial Home Health Care, Nursing Home or Assisted Living Request forms: EE-17A and EE-17B

A regulatory change to the EEOICPA Final Rule was published on February 8, 2019, and went into effect April 9, 2019. This change made OMB forms EE-17A and EE-17B required for initiating initial (claimant has never received services through EEOICPA) authorization requests for home health care, hospice, assisted living, and nursing home care. Upon implementation of the forms on June 3, 2019, medical providers will no longer submit authorization request forms to Conduent to initiate care for the aforementioned service types when the claimant requests care for the first time. However, the authorization details (approved, denied, or pending) concerning these requests will continue to be processed and transmitted to Conduent. All emergency temporary authorization requests, or requests for reauthorization, or requests for an amended level of care will continue to be submitted to Conduent using the existing processes.

Review the EE-17A and EE-17B forms.
 

DEEOIC Web Portal Announcement - Target Case Management for Home Health Care

Effective April 25, 2019, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) released a new policy regarding Targeted Case Management (TCM). TCM authorization requests submitted prior to April 25, 2019, are not impacted by the new policy.

Targeted Case Management (TCM) can occur when a claimant is prescribed multiple types or levels of care related to their covered condition(s). TCM is the coordination of different care providers (such a Home Health Aids, RNs, Therapists, etc.), and the different treatments being provided to assure that the medical care is appropriately scheduled, and that treatments don't inappropriately overlap or have unintended negative impacts on the claimant's health. This process facilitates services provided and assists claimants in gaining access to needed medical, social, educational, and other services directly related to their DEEOIC accepted condition(s).

DEEOIC does not reimburse for the supervision and monitoring of staff by RNs or other higher credentialed individuals. DEEOIC considers the supervision of home health care staff to be the inherent responsibility of the medical provider that the claimant chooses to provide health care services. The training or continuing education of health care personnel is also not considered TCM or reimbursed.

See the EEOICPA circular on Targeted Case Management for Home Health Care.