Please Note: We have a new Enrollment fax number for providers who want to submit an Enrollment Application.
All completed online Enrollment Applications should faxed to: (888) 444-5335, and your application will be processed accordingly
Effective August1, 2014, the following Office of Workers' Compensation Programs (OWCP), Division of Federal Employees Compensation (DFEC) and the Division of Energy Employees Occupational Illness Compensation (DEEOIC), will implement a new reimbursement methodology which will be based on the Medicare Outpatient Prospective Payment System (OPPS). The payment method will utilize Medicare's Ambulatory Payment Classifications (APC) as well as the OWCP Fee Schedule. Outpatient bills submitted with a date of service before August 1, 2014, will be priced based on the OWCP Fee Schedule. Outpatient bills submitted with a date of service on or after August 1, 2014 will be priced based on the APC rate and/or OWCP Fee Schedule. The new method will apply to outpatient care in all acute care hospitals, including general hospitals, freestanding rehabilitation hospitals and long-term care hospitals, with the exception of Critical Access Hospitals and Maryland Hospitals. When submitting an OWCP-04 form for Outpatient services, providers will be required to enter their Medicare Number in box 51. If the Medicare Number is missing or invalid, the bill will be denied.
Effective May 1, 2014, the Office of Workers' Compensation Programs (OWCP) will begin calculating the maximum allowable fee for pharmacy billings of prescription drugs using a formula which differentiates between brand name drugs and generic drugs. The maximum allowable fee for brand name drugs will be 90% of the average wholesale price (AWP) plus a $4.00 dispensing fee, and the maximum allowable fee for generic drugs will be 75% of the AWP plus a $4.00 dispensing fee. This change will affect prescriptions paid under all of the OWCP Programs; Division of Energy Employees' Occupational Illness Compensation (DEEOIC), and Division of Coal Mine Workers Compensation (DCMWC). For the Division of Federal Employees' Compensation (DFEC), the maximum allowable fee for brand name drugs will be 90% of the average wholesale price (AWP) plus a $4.00 dispensing fee, and the maximum allowable fee for generic drugs will be 70% of the AWP plus a $4.00 dispensing fee.
On April 1, 2014, The President signed the SGR Patch bill, HR-4302, which called for the delay of ICD-10 CM/PCS implementations until October 1, 2015. The Office of Workers' Compensation Programs (OWCP), in accordance with the bill passed, will delay the implementation of ICD-10 CM/PCS until October 1, 2015. Although there is a delay in the implementation of ICD-10 CM/PCS, OWCP will be requesting that provider's begin using the revised 1500 claim form (version 2/12) to report services rendered using the ICD-9 CM Coding schemas, effective March 1, 2014.
We will be following CMS guidance for implementing ICD-10 on October 1, 2015. Please visit the CMS ICD-10 website for additional information, resources and the latest news on the ICD- 10 transition,
Effective March 1, 2014, We will accept paper bills submitted on the revised 1500 claim form (version 2/12) with ICD-9 codes.
For information about ICD-10 or 1500 form changes click here.
Attention DEEOIC DME Providers - The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has released new guidelines concerning the authorization of durable medical equipment (DME). For information about these new guidelines, please click here
The Division of Federal Employee’ Compensation Act (DFEC) has released new guidelines implementing service limitations for injection CPT codes 20550, 20551, 20552, 20553, and 20526, which goes into effect August 1, 2013.
CPT codes 20550 and 20551 will reimburse 4 encounters within a 12 month period with no additional encounters for the claimant after that year, and for the same case number.
CPT codes 20552 and 20553 will reimburse 10 encounters within a 12 month period with no additional encounters for the claimant after that year, and for the same case number.
CPT code 20526 will reimburse 3 injections within a 12 month period.
Effective 08/01/2013, The Office of Workers' Compensation (OWCP) will no longer utilize DOL homegrown procedure codes RP120, RP130 AND RP200 (Pain Management). When rendering Pain Management services, providers are to bill and/or submit for prior authorizations using the appropriate HCPCS/CPT codes applicable for the services. Request for prior authorizations for pain management services should include but not be limited to a complete and detailed treatment plan.
As of 03/30/08 a new feature called Provider Search is being offered to all three programs. This feature will help you generate a custom list of providers by entering criteria that describes what you are looking for. When searching the database the search may include the program name, provider type, specialty, provider name, city, state, and zip code. To get started click the Provider Search link in the Available Features section.
- User Activity Reports
- Portal Inquiries
- Entry of Medical Authorizations
- Entry of Provider Enrollments
- Updated portal usage statistics