Effective October 26, 2024, the Office of Workers’ Compensation Programs (OWCP) will implement new utilization review to assign limits for specific services.

This utilization review will apply to three OWCP Programs: FECA (DFEC), DCMWC, DEEOIC.

New limits have been defined for the following services:

For questions, contact our Call Center at the applicable phone number listed below, where a representative will be happy to assist you.

• Division of Coal Mine Workers' Compensation (DCMWC):
  1-800-638-7072
• Division of Energy Employees Occupational Illness Compensation (DEEOIC):
  1-866-272-2682
• Division of Federal Employees' Compensation (DFEC):
  1-844-493-1966

Effective August 24, 2024, providers will be required to submit billing NPI when billing for services provided to injured or ill workers for the Office of Workers’ Compensation Programs (OWCP). Professional and institutional bills submitted without the billing NPI after August 24,2024 will be denied.

Note: Providers are strongly encouraged to submit the billing taxonomy.

Billing NPI is not required for OWCP bills submitted from providers such as non-medical vendors, fiscal intermediaries, and non-emergency transportation.

• 33 Contract Medical Consultant
• 41 Contract Nurse
• 43 Taxi
• 44 Public Transportation & Private Transportation
• 53 Non-Medical Vendor
• 55 Vocational Rehabilitation (Training, Tuition and Schools)
• 56 Vocational Rehabilitation Counselor
• 57 Rehabilitation Maintenance
• 58 Assisted Re-employment
• 59 Relocation Expenses
• 61 Second Opinion Contractor
• 80 Pay-to-Intermediary
• 89 Federal Facility (VA Hospital)
• 94 Boarding House
• 95 Insurance Company (Third Party Carriers)
• 97 Billing Agent
• 98 Lien holder

Online Bill Entry (web portal direct data entry): Refer to the Direct Data Entry Billing Tutorial for instructions and examples.

Mail (paper form): Refer to the billing instructions for each claim form by visiting the OWCP Forms and References page and selecting the OWCP Program (DCMWC, DEEOIC, or DFEC).

Additional Reminders:

For the Health Insurance Claim Form (OWCP-1500):

• Enter billing information in Box 33. Billing provider NPI must be entered in Box 33a. Enter billing taxonomy in Box 33b.
• Be sure to enter your OWCP Provider ID in Box 33 per the form instructions. Do not enter your 9-digit billing OWCP provider ID using Box 33b.
• Enter servicing facility information in Box 32. Enter servicing facility NPI in Box 32a and servicing facility taxonomy in Box 32b.
• Enter servicing (rendering) provider information in Box 24J. Enter servicing (rendering) NPI in the unshaded area of Box 24J and servicing (rendering) taxonomy in the shaded area of Box 24J.

For Uniform Health Insurance Claim Form (OWCP-04):

• Billing provider NPI must be entered in Box 56. Enter billing taxonomy in Box 81CCa.
• Enter attending (servicing) provider NPI in Box 76 and attending (servicing) taxonomy in Box 81CCb.

For ADA Dental Claim Forms:

• Billing provider NPI should be entered in Box 49. Enter billing taxonomy in Box 52a.
• Enter treating (servicing) NPI in Box 54 and treating (servicing) taxonomy in Box 56a.

EDI (HIPAA 837s): Refer to the updated 837 Companion Guide.

• 837 file segment details for billing provider NPI and taxonomy

  NPI or Taxonomy	837 File Segment
  NPI	Loop – 2010AA Segment – NM1 NM108: Identification Code Qualifier = XX (REQUIRED) NM109: Identification Code Qualifier = NPI (REQUIRED)
  Taxonomy	Loop – 2000A Segment – PRV PRV01: BI (Billing) PRV 01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽BI✽PXC✽207Q00000X~

• 837 file segment details for servicing provider NPI and taxonomy

  Claim Type	Location	NPI or Taxonomy	837 File Segment
  Professional/Dental	Header	NPI	Loop: 2310B — RENDERING PROVIDER NAME Segment: NM1✽82 NM108: Identification Code Qualifier = XX NM109: NPI NM109 is required when NM108 is available Example : NM1✽82✽1✽DOE✽JANE✽C✽✽✽XX✽1234567804~
  		Taxonomy	Loop: 2310B - RENDERING PROVIDER SPECIALTY INFORMATION Segment: PRV PRV01: PE (Performing) PRV01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽PE✽PXC✽1223G0001X~
  	Line	NPI	Loop: 2420A — RENDERING PROVIDER NAME Segment: NM1✽82 NM108: Identification Code Qualifier = XX NM109: Identification Code Qualifier = NPI NM109 is required when NM108 is available Example: NM1✽82✽1✽DOE✽JANE✽C✽✽✽✽XX✽1234567804~
  		Taxonomy	Loop: 2420A — RENDERING PROVIDER SPECIALTY INFORMATION Segment: PRV PRV01: PE (Performing) PRV01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽PE✽PXC✽208D00000X~
  Institutional	Header	NPI	Loop: 2310A - ATTENDING PROVIDER NAME Segment: NM1✽71 NM108: Identification Code Qualifier = XX NM109: Identification Code Qualifier = NPI NM109 is required when NM108 is available Example: NM1✽71✽1✽JONES✽JOHN✽✽✽✽XX✽1234567891~
  		Taxonomy	Loop: 2310A - ATTENDING PROVIDER SPECIALTY INFORMATION Segment: PRV PRV01: AT (Attending) PRV01 is required if PRV loop is present PRV02: PXC (Qualifier for taxonomy code) PRV02 is required if PRV01 is present PRV03: Provider taxonomy code PRV03 is required if PRV02 is present Example: PRV✽AT✽PXC✽208D00000X~

Messaging will appear on your remittance voucher to alert you of any NPI or taxonomy information that is missing or does not match your provider file.

For questions, contact our Call Center at the applicable phone number listed below, where a representative will be happy to assist you.

Division of Coal Mine Workers' Compensation (DCMWC):
1-800-638-7072

Division of Energy Employees Occupational Illness Compensation (DEEOIC):
1-866-272-2682

Division of Federal Employees' Compensation (DFEC):
1-844-493-1966