Effective 05/14/2012, for OWCP Programs, all prescription drugs dispensed from a physician’s office and submitted with procedure codes J3490, J8499, J8999, and J9999 will require an accompanying original National Drug Code (NDC). All physician dispensed prescription drugs submitted correctly with the drug’s original NDC will process through the Pharmacy Benefits Management System and based on the date of service will price according to 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 will be denied.
For FECA/Black Lung Program: Any physician dispensed prescription drugs submitted using procedure code 99070 will require an accompanying original National Drug Code (NDC). Services submitted using procedure code 99070 without an accompanying description of the supplies or other materials provided (except spectacles) will be denied.
For Energy Program: Services submitted with procedure code 99070 will be denied. The Energy Program requires a level II HCPCS code.
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.helpdesk@acs-inc.com 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.
Effective 12/23/10, 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. 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 200 miles per day.
Click here to view the document
PHARMACY PROCESSING - Effective September 29, 2011, pharmacy billings will be based on the Average Whole Price as published by Medi-Span.
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
Attention: PCC
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 wcproviders@p2plink.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).
Effective May 1, 2011, ACS DOL will provide mandatory electronic funds transfer (EFT) for all new worker’s compensation payers and medical providers that enroll into Department of Labor Office of Workers' Compensation programs. Click here for more information
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.
Effective 12/23/10, 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. Travel services for codes A0100, A0110, A0120, A0130, and A0140 are authorized based on private transportation total charges. Travel services for claimant mileage reimbursement or non-interest/interest escorts billed using codes A0080 and A0090 will be authorized based on the number of miles/units billed (round trip).
Effective 12/05/10, the fee schedule allowance for anesthesia services will be based upon the formula: (Time Units + Base Units) x Conversion Factor. In addition, every anesthesia procedure billed to OWCP must include one of the following modifiers: AA, QY, QK, AD, QX, or QZ. When multiple procedures are performed during a single anesthetic administration, reimbursement is based on the line item representing the most complex procedure.
The Office of Worker's Compensation (OWCP), Federal Employees Compensation Program; effective 07/01/2010 will no longer utilize DOL homegrown procedure code RP100 (Pain Management). When rendering Pain Management services, providers are to bill and/or submit for prior authorizations 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.
Effective 07/15/2010, DOL will require the place of service to be present on the HCFA1500 (Box 24b). After the effective date, any HCFA1500 received without the place of service will be returned to the provider for correction. This requirement change does affect any facility services billed on a UB04 or professional services billed for Third Party Carriers, Billing Agents, Contract Nurses, Second Opinion Contractors, and Vocational Rehabilitation services such as Rehab Maintenance, Assisted Re-Employment, Relocation Expenses, and Counseling.
Effective 03/29/2010 the Office of Workers Compensation Program and the Division of Federal Employees Compensation (DFEC) Program implemented the new "Automated Adjustment Process". This new process will provide the following enhancements in the submission of bill adjustment request, received from the Medical Provider and Claimant community:
- Faster, more efficient processing
- Systematic notification of credit balance(s) owed to DOL
- Automatic recovery of overpayments
- Automated adjustment processing upon receipt of a request
Additional information and training can be found on the ACS Web Billing Processing Portal https://owcp.dol.acs-inc.com titled "DEFC Automated Adjustment Process".
The US Department of Labor's Office of Workers' Compensation Programs (OWCP) will adhere to the recent decision by the Center for Medicare and Medicaid Services (CMS) that was announced in MLN Matters, #MM6740. Effective March 1, 2010 OWCP will no longer accept the use of the AMA/CPT Consultation codes ranges 99241-99245 and 99251-99255 for inpatient/outpatient facilities and office settings. Any line items submitted with date of service on or after March 1, 2010 will be denied and returned stating "The requested procedure is not a covered service". For additional information please refer to CMS MLN Matters Number: MM6740 located at:
http://www.cms.gov/MLNMattersArticles/downloads/MM6740.pdf
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