If you or someone you know has a medical condition not related to a workers' compensation injury or illness and doesn't have health insurance, or if you are a physician treating someone without health insurance, please click here
to learn about the new Health Insurance Marketplace created under the Affordable Care Act.
Effective immediately, all providers enrolled in a U.S. Department of Labor Office of Workers’ Compensation Program must transition to mandatory electronic funds transfer (EFT) prior to March 1, 2013. Failure to comply will result in suspension of bill payment after March 1, 2013. Click here for more information
The Division of Energy Employees Occupational Illness Compensation (DEEOIC) has released new guidelines concerning the authorization of massage and/or manual therapy. For information about these new guidelines, please click here
Effective 12/23/2010, DFEC transportation providers may request prior authorization for travel services using the secure online Medical Authorization Entry page or via fax using the auth request template available on the "Forms and Links" page. Billing of travel codes A0100, A0110, A0120, A0130, A0140, and A0170 will require a submitted receipt or invoice, and prior authorization when the total charge for these services exceeds $75.00 per day. On 12/24/2012 a reduction in the mileage accepted per day was reduced from 200 miles to 100 miles. Travel services for claimant mileage reimbursement or non-interest/interest escorts billed using codes A0080 and A0090 will require prior authorization when the mileage exceeds 100 miles per day.
Click here to view the document
Effective September 1, 2012, all DEEOIC medical bills submitted to ACS lacking a required prior authorization will be automatically denied.
To determine if the service you are providing requires prior authorization, please visit https://owcp.dol.acs-inc.com/sso/login.do
or call 1-866-272-2682 for assistance. To access the URL above, you must complete, or have completed Web Portal registration. This can be done by visiting https://owcp.dol.acs-inc.com/sso/registration/providerAccount.do
. If you require assistance trying to register, please contact the Web Portal Help Desk at
To obtain the appropriate authorization request forms, please visit https://owcp.dol.acs-inc.com/portal/formsAndLinks.do
and click on the link for Division of Energy Employees Occupational Illness Compensation (DEEOIC) or call 1-866-272-2682 for more information.
Please Note - All requests for authorization should include medical rationale from the treating physician. Failure to include this may result in delays in processing and/or denied requests.
Effective June 17, 2012, prescription drugs dispensed from a physician's office, or submitted by non-pharmacy provider’s acting in a capacity as a billing agent for the purpose of dispensing pharmaceuticals, using procedure codes J3490, J8499, J8999, and J9999 will require an accompanying original National Drug Code (NDC), the Days Supply, and the physicians/organizations National Provider Identifier (NPI). All dispensed prescription drugs submitted correctly with the drug's original NDC will process through the Pharmacy Benefits Management System and will be priced based on the date of service in accordance with the published Average Wholesale Price (AWP) or the Medispan Average Wholesale (MAW) benchmark pharmacy rate. Services submitted for any of these codes without an accompanying NDC, Days Supply, line item charge and/or the NPI will be returned back to the sender.
Effective January 1, 2012, DCMWC will reimburse physician bills based on the 1st diagnosis on the HCFA-1500. The first diagnosis must be disease specific (pulmonary related) in order for the bill to be considered for reimbursement.
User acceptance testing will be extended until February 1, 2012. Effective January 31, 2012, the standard 4010 HIPAA transactions will NO LONGER BE ACCEPTED by ACS DOL. Effective February 1, 2012, ACS DOL will accept the standard 5010 HIPAA transaction ONLY. All other transactions must be submitted via paper to P.O. Box 8300, London, KY 40742-8300 (FECA transactions), P.O. Box 8302, London, KY 40742-8302 (Black Lung transactions) or P.O. Box 8304, London, KY 40742- 8304 (Energy transactions). ACS DOL services will be enhanced to facilitate the new transaction standards in a timely manner for our submitter community. ACS DOL has posted 5010 companion guides for our submitters along with the 4010 companion guides on our website at http://www.acs-gcro.com. ACS DOL is currently engaging with electronic bill submitters to perform user acceptance testing for our implementation readiness. P2P will begin accepting the 5010 electronic formats in the 4th Quarter of 2011.
For additional information, please visit ACS Bill Processing Portal at http://owcp.dol.acs-inc.com or contact HCSOC.firstname.lastname@example.org to schedule testing. Once testing has been completed and submitters are ready for production, we will accept electronic production files from the submitters. Once a submitter begins to send 5010 electronic transactions in production, we can no longer accept 4010 transactions.
Click here for 5010 Electronic Submission Provider Training Material.
Effective 10/01/2011, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) approved Impairment Evaluations performed by *non-contract physicians should be billed under CPT 99455 (Treating Physician) or 99456 (Non-Treating Physician). Reimbursement for these services will be in accordance with the OWCP fee schedule. ALL requests for impairment evaluations require prior authorization from the DEEOIC claims examiner. Impairment Evaluations that are not approved by DEEOIC are not eligible for payment.
In addition diagnostic services related to Impairment Evaluations must be billed with the appropriate CPT codes. Reimbursement for these services will be in accordance with the OWCP fee schedule. Supporting documentation (e.g. medical reports, evaluation reports, assessment reports and diagnostic testing results) must be submitted with the completed OWCP-1500.
*DEEOIC defines non-contract physicians and providers as physicians or medical providers who do not currently have a formal agreement or contract to accept a set fee for services provided to DEEOIC claimants.
Please be advised that the United States Department of Labor (DOL), Division of Federal Employees Compensation (DFEC) will begin converting personal and business checks submitted as refunds into an electronic funds transfer (EFT) effective February 1, 2011. The information used from the payer's check during the electronic fund transfer will allow funds to be with drawn from the account as soon as the payment is received. The DFEC Privacy Act Statement Required by 5 USC 552A (E) (3) is available at https://www.pccotc.gov/pccotc/index.htm
OR CALL TOLL FREE 866-945-7920. All refunds (payments you received in error or money owed to DOL) should be forwarded to:
U.S. Department of Labor
Division of Federal Employees Compensation Program
P.O. Box 37117
Washington, DC 20013-7117.
Providers submitting bills through a clearinghouse, billing agent or vendor have three options to submit their bills electronically: EDI ACS Gateway, P2P Link or the DOL OWCP Web Bill Processing Portal (Web Portal). If you are interested in getting connected via P2P Link, you can contact them directly at 469-417-7757 or via email at email@example.com. For DOL OWCP Web Portal or EDI ACS Gateway, go to "Forms and Links" or contact them at 1-800-461-7485 or 1-850-558-1775. EDI ACS Gateway, P2P Link or the DOL OWCP Web Portal will provide essential electronic connectivity between workers' compensation payers and medical providers, as well as functionality for all Department of Labor Office of Workers' Compensation (OWCP) programs (FECA, DCMWC, and DEEOIC).
On May 3rd, 2011, The Department of Labor (DOL) will be implementing a new policy for processing Schedule II drugs for claimants who are identified as recipients under the Federal Employees Compensation Act (FECA) Program. Patients who do not have a diagnosis of cancer as an accepted work-related medical condition and have not received a fentanyl prescription in the past six months will no longer be able to receive fentanyl prescriptions, except for Duragesic. Patients with a diagnosis of cancer as an accepted work-related medical condition will continue to be able to receive Schedule II medications, including fentanyl products, in the same manner as today. All Schedule 2 prescriptions continue to be subject to early refill limitation and days' supply limitations. This includes the requirement that a claimant use 75% of the previous fill before being allowed to receive another fill of the same Schedule 2 medication and that a Schedule II fill be limited to 30 days. Please contact the PBM call center @ 866-664-5581 with any questions about these changes.