To access Provider Enrollment :
[Program Name] - Provider > Accept > Provider Enrollment
OR
Click the Provider Enrollment hyperlink available on the web bill processing portal home page.
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To access Provider Enrollment : [Program Name] - Provider > Accept > Provider Enrollment OR Click the Provider Enrollment hyperlink available on the web bill processing portal home page. |
The new Provider Enrollment function allows providers to enter OWCP program enrollment information online and immediately obtain a provider number. The portal still allows providers to create a copy of their provider enrollment form in PDF format. Additionally, new providers can automatically create a web portal account, allowing them to access secure features of the web bill processing portal. Those providers who do not wish to enroll via the web can download an enrollment form from the Forms & Links page.
The selected Enrollment Type, Practice Type, and OWCP Program(s) determines which enrollment pages will be completed by users. The enrollment web pages for individuals (individuals or sole proprietorships that do not have an EIN, or Employer Identification Number) and facilities (hospitals, nursing homes, or acute care facilities) differ slightly from those for group practices (a corporation, partnership, other business entity, or sole proprietorship that has an EIN, or Employer Identification Number).
After the user has completed the information on all of the web pages, the enrollment application can be submitted. If all of the information is complete and valid, then the portal will return a confirmation page indicating the provider's ID and status (E.g., Active or Pending). Samples of each enrollment page are shown below. For the purposes of this help manual, the sample pages are for: New Enrollment, Individual, FECA, DEEOIC, and DCMWC programs. Users who are enrolling in a different manner (i.e. "Facility, Group, Enroll in additional programs") should still be able to obtain the information they need from this help document.
The Provider Enrollment - Enrollment Type Selection page allows the user to enter contact information as well as some general enrollment information. By providing contact information, you can be contacted in a timely manner should there be a question about any information entered on your enrollment form.
Enter the following information:
CONTACT INFORMATION
Last Name (REQUIRED) - 20 alpha characters
First Name (REQUIRED) - 15 alpha characters
MI (Optional) - 1 alpha character
Office Phone (REQUIRED) - 10 digit numeric; only digits are allowed - do not enter dashes, spaces, or parentheses
Office Email (REQUIRED) - 80 alphanumeric characters; must be in standard email address format (E.g., yourname@acme.com); your initial password for access to the web portal's secure features will be sent to this email address
ENROLLMENT TYPE
Select the appropriate enrollment type from the list of radio buttons:
New enrollment - provider is not currently enrolled in any OWCP programs
Enroll in additional programs - provider is currently enrolled in at least one OWCP program and wishes to enroll in one or more additional OWCP program(s)
Add new member to group (FECA Only) - group provider is currently enrolled in the FECA program and wishes to add new members to the group practice
Click the Continue button to proceed to the next page in the Provider Enrollment application.
Enter the following information:
PRACTICE TYPE
You are REQUIRED to select a practice type:
Individual - Select this practice type if you are an individual or sole proprietorship that does not have an Employer Identification Number (EIN).
Facility - Select this practice type if you are a hospital, nursing home, or acute care facility.
Group - Select this practice type if you are a corporation, partnership, other business entity, or sole proprietorship that has an Employer Identification Number (EIN).
Click the Continue button to proceed to the next page in the Provider Enrollment application.
Enter the following information:
PROGRAM SELECTION
Select the checkbox corresponding to each program for which you are enrolling. Select the "All Programs" checkbox to enroll in all of the OWCP programs.
GENERAL INFORMATION
Enter your SSN or EIN (REQUIRED) - 9 digit numeric; only digits are allowed - do not enter dashes or spaces
Enter the earliest date that you treated a participant in any OWCP program (Optional) - mm/dd/ccyy format
Click the Continue button to proceed to the next page in the Provider Enrollment application.
Enter the following information:
PRACTICE ADDRESS
Practice Name (REQUIRED) - 35 alphanumeric characters
Practice Address 1 (REQUIRED) - 28 alphanumeric characters
Practice Address 2 (Optional) - 28 alphanumeric characters
City (REQUIRED) - 18 alphanumeric characters
State (REQUIRED) - Drop down list
Zip Code (REQUIRED) - 5 or 9 numeric characters (no hyphens or spaces)
Office Phone (REQUIRED) - 10 digit numeric; only digits are allowed - do not enter dashes or spaces
Office Fax (Optional) - 10 digit numeric; only digits are allowed - do not enter dashes or spaces
BILLING ADDRESS
Users have two options:
Select the "Same as Practice Address" check box - if you select this option, the Billing Address fields will be pre-populated with the same information entered in the Practice Address section.
Supply a different address by entering the appropriate data in the proper fields.
Electronic Funds Transfer (REQUIRED for DEEOIC or DCMWC enrollment; Optional for FECA enrollment)
Select the Electronic Funds Transfer checkbox and enter the required EFT information:
Type of Account (REQUIRED) - options are Checking or Saving
Routing Number (REQUIRED) - 9 digit numeric; the 9 digit number associated with a financial institution which serves as its unique identifier for funds movement throughout the Federal Reserve processing system.
Account Number (REQUIRED) - 17 digit numeric
Bank Name (REQUIRED) - 35 alphanumeric characters
State (REQUIRED) - Drop down list
Electronic RV
Select the Electronic RV checkbox if you are interested in receiving electronic remittance vouchers.
Click the Continue button to proceed to the next page in the Provider Enrollment application.
Enter the following information:
PROVIDER TYPE
Provider Type (REQUIRED) - select from the drop down list the Provider Type that most closely describes the service(s) that you provide
Explanation (Conditional) - required if selected Provider Type is (53) Non-Medical Vendor
Medicare Number (Conditional) - required if selected Provider Type is (01) Acute/General Hospital
LICENSE AND CERTIFICATION
Last Name (REQUIRED)
First Name (REQUIRED)
MI (Middle Initial) - (Optional)
The following fields are only available if Provider Type (25) Physician (M.D.) or (26) Physician (D.O.) was selected:
Title (REQUIRED)
License # (REQUIRED)
State (REQUIRED) - drop down list
Current License Expiration Date (REQUIRED) - mm/dd/ccyy format
Specialty Code (Optional) - select from the drop down list the Specialty Code that most closely describes your medical specialty
Certification Expiration Date (Conditional) - required if Specialty Code field is populated; mm/dd/ccyy format (E.g., 01/01/2004)
Click the Continue button to proceed to the next page in the Provider Enrollment application.
New enrollees are prompted to enter a User ID to be used to access secure features, such as inquiry functions, of the web bill processing portal. Once the enrollment is successfully processed, a temporary password is emailed to the email address provided on the Enrollment Type Selection page.
The Provider Enrollment - Statement page includes a Privacy Act Statement; no data needs to be entered on this page. Click the Submit Application button to process the request. If there are any errors, then the portal indicates the error and navigates the user to the appropriate page. If all data is valid, then the enrollment is processed and the Provider Enrollment - Confirmation page opens.
The Provider Enrollment - Confirmation page contains an ENROLLMENT section, which indicates the provider number, name, programs enrolled, and enrollment status. Providers should note their provider number as it will be required when submitting bills and for the portal's web registration.
Providers are also encouraged to print and retain a copy of their application by clicking on the 'Click here to print a copy of your application to retain for your records' hyperlink. Doing so will create a PDF copy of the enrollment application; Adobe Acrobat Reader must be installed on your computer to access PDF files. If you do not have this software program, you can download it (for free) by clicking on the Get Acrobat Reader icon.
NOTE: Newly enrolled Physician (M.D.) and Physician (D.O.) providers must mail or fax a copy of their medical licenses to the provider enrollment unit prior to submitting bills.
For new enrollees, the Confirmation page also contains a WEB PORTAL ACCOUNT section, which displays the information needed for a provider to access the web portal's secure functionality.
NOTE: After successfully, you do NOT need to send a paper copy of the provider enrollment application to the enrollment unit. A PDF version of the completed enrollment application is available for you to print and retain a copy for your records.
