To be paid for treating federal employees covered by the FECA, you must enroll. As of March 31, 2004, all bills submitted by unenrolled Providers will be returned along with instructions on how to enroll. Enrollment is free and is simply a registration process to ensure proper payments. It is not a PPO enrollment.
To enroll, please complete and submit the Provider Enrollment Form (OWCP-1168). Additional information on provider enrollment is available on the OWCP Web Bill Processing Portal.
Go to the Portal. Click on "Provider" in the FECA section. Then click on "Web Registration" and follow the instructions. If you try this and have questions, need technical support or require additional assistance, call the Health Care Solutions Operations Center Helpdesk at 1-800-461-7485 or 1-850-558-1775.
To use the on-line authorization, bill status, and payment status functions, a provider must enroll and must register to use the web portal. Both enrollment and web registration can be accomplished on the Portal.
Whenever you treat an Injured Worker, check the OWCP Web Bill Processing Portal.
Level 1 procedures (for example, office visits, MRIs without contrast, and some other routine diagnostic tests) do not require authorization. If you need a hard copy confirmation of this, complete an online authorization request on the Portal and print the message displayed after the request is submitted.
Level 2, 3 and 4 procedures require authorization. These authorization requests can be made on the Portal or by faxing a completed authorization request and supporting documentation to 800-215-4901. The Medical Authorization forms are available on the Portal. Click on Resources - "Forms and References" and then choose DFEC. Forms are available for Durable Medical Equipment, General Medical/Surgery, and Physical Therapy authorizations. These forms request the specific information needed to process each type of authorization request.
You may request authorization on the OWCP Web Bill Processing Portal. Or, you may fax the appropriate Medical Authorization form and supporting documentation to 800-215-4901. The Medical Authorization forms are available on the Portal. Click on Resources – "Forms and References" and then choose DFEC. Forms are available for Durable Medical Equipment, General Medical/Surgery, and Physical Therapy authorizations.
CA-16s are issued by Employing Agencies to Injured Workers so they can seek immediate medical care. When there is a CA-16, NO authorization is needed for office visits and consultations, labs, hospital services (including inpatient), X-rays (including MRI and CT scan), physical therapy, and Emergency services (including surgery) related to the work injury. You must enroll as a Provider to be paid for services provided under a CA-16. The CA-16 DOES NOT cover non-emergency surgery, home exercise equipment, whirlpools, mattresses, spa/gym memberships, and work hardening programs. Authorization for these services cannot be requested until a claim number has been established.
An authorization is not required when an Injured Worker is referred by her/his treating physician to a specialist for a consultation. However, you must be enrolled as a Provider to be paid for the consultation visit.
Request authorization on the OWCP Web Bill Processing Portal or fax the appropriate Medical Authorization form and supporting documentation to 800-215-4901. The Claims Examiner will determine if the claim can be expanded for a new condition based on information in file and information submitted with the request or if additional development is needed.
If you believe a medication is necessary for the treatment of the injured worker's accepted conditions please submit medical documentation for review by the claims examiner. As is the case with anything sent to OWCP, please be sure to include the injured worker's claim/case number on every page. Please mail all documentation to U.S. Department of Labor, OWCP/DFEC, PO Box 8300, London, KY 40742-8300.
This information is available on the OWCP Web Bill Processing Portal.
If an injured worker believes that additional or different conditions warrant acceptance on her/his claim, s/he needs to submit to OWCP medical documentation supporting expansion of the claim for review by the claims examiner. As is the case with anything sent to OWCP, this medical documentation should include the injured worker's claim/case number on every page and should be mail to U.S. Department of Labor, OWCP/DFEC, PO Box 8300, London, KY 40742-8300.
Injured Workers and Providers can check on the status of medical authorizations on the OWCP Web Bill Processing Portal. To speak with a Customer Service Representative regarding an authorization, you may call 844-493-1966, toll free. This number is available Monday to Friday, 8am to 8pm, EST.
Injured Workers, Providers, and Employing Agencies can check on the status of bills and reimbursements on the OWCP Web Bill Processing Portal. To speak with a Customer Service Representative regarding a bill or reimbursement, you may call 844-493-1966, toll free. This number is available Monday to Friday, 8am to 8pm, EST.
Yes! Using Electronic Data Interchange (EDI) has many benefits including
Information about this option is available through EDI Solutions online or by calling the EDI Technical Support line at 800-987-6717.
Yes. Go to the Portal and click on the Help link.
No, you may not seek additional payment. If an authorized service has been rendered for the injured worker's accepted work-related condition, he or she is not responsible for charges over the maximum allowed in the OWCP fee schedule or other tests for reasonableness. 20 C.F.R. §10.801 (d) provides that by submitting a bill and/or accepting payment, the provider signifies that the service for which reimbursement is sought was performed as described and was necessary. In addition, the provider thereby agrees to comply with all regulations concerning the rendering of treatment and/or the process for seeking reimbursement for medical services, including the limitation imposed on the amount to be paid for such services. Therefore, if your bill is reduced by OWCP in accordance with its fee schedule, you may not charge the injured worker for the remainder of the bill. See also 20 CFR §10.813 and §10.815 (h).
The Federal Fee Schedule is applied to medical bills and to some durable medical equipment bills. Access the Federal Fee Schedule free of charge on the OWCP fee schedule page.
Send all bills for Federal workers' compensation cases to:
U.S. Department of Labor
OWCP/DFEC
PO Box 8300
London, KY 40742-8300
Please be sure to include the claim number on every page you send.