Logical Answers to Practical Questions -- for Injured Workers

Where do I send mail?

All mail and bills for Federal workers’
compensation cases should  be sent to:

U.S. Department of Labor
DFEC Central
Mailroom
PO Box 8300
London, KY 40742-8300

Be sure to include the claim number on
EVERY page you send.

I just found out you won’t authorize or
pay for treatment/medication my doctor prescribed. What do I do now?

We have recently enhanced our computer
system to ensure that the care the injured worker is receiving is relevant
to the condition(s) for which the case was accepted. These enhancements
were made in accordance with the Federal Employees’ Compensation Act which
mandates OWCP to furnish an injured worker with services, appliances, and
supplies prescribed by a qualified physician which OWCP deems likely “to
cure, give relief, reduce the degree or the period of disability, or aid
in lessening the amount of monthly compensation.” While we have always had
processes in place to help assure that OWCP authorizes and pays only for
services, treatments, medications, and durable medical equipment related
to the accepted conditions on a claim, our recent computer enhancements
provide more rigor to these processes.

As a result of this, some injured workers
may find that treatment or medications previously allowed are no longer
available to them. If an injured worker’s physician believes a treatment,
procedure, or medication is necessary for the treatment of the injured
worker’s accepted conditions, the provider needs to 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, DFEC Central Mailroom, P.O. Box 8300, London, KY
40742-8300.

How do I learn the status of a medical
authorization request?

Injured Workers, Providers, and Employing
Agencies can check on the status of medical authorizations at https://owcp.dol.acs-inc.com/portal/main.do. Having this information on the web is beneficial
since authorization information is available 24 hours/day, 7 days/week
without calling for an authorization number or waiting for the receipt of
an authorization letter in the mail.  Claimant eligibility, bill
status, and medical authorization inquiry functionality is also available
24 hours a day via our Interactive Voice Response (IVR) system. To access
the IVR, call 866-335-8319. To speak with a Customer Service
Representative regarding an authorization, you may call 850-558-1818 which
will be a toll call. This number is available Monday – Friday, 8am – 8pm,
EST.

How do I learn the status of a bill or
claim for reimbursement?

Injured Workers, Providers, and Employing
Agencies can check on the status of bills and reimbursements at https://owcp.dol.acs-inc.com/portal/main.do. Claimant eligibility, bill status, and medical
authorization inquiry functionality is also available 24 hours a day via
our Interactive Voice Response (IVR) system. To access the IVR, please
dial 866-335-8319. To speak with a Customer Service Representative
regarding a bill or reimbursement, you may call 850-558-1818 which will be
a toll call. This number is available Monday – Friday, 8am – 8pm, EST.

How do I do find out my accepted
conditions?

While your initial acceptance letter
includes this information, claims are often updated to include other
conditions. This information is now available online at https://owcp.dol.acs-inc.com/portal/main.do
click on the "Eligibility and Accepted
Conditions" link. You can help your Provider by giving her/him the list of
accepted conditions for your claim and by telling her/him how to access
this information online.

I think that other diagnoses need to be
added as accepted conditions on my claim.  What should I
do?

If you believe that additional or
different conditions warrant acceptance on your claim, please provide OWCP
with medical documentation supporting the claim's expansion for review by
the claims examiner.  As is the case with anything sent to OWCP, this
medical documentation must include the claim/case number on every page and
should be mailed to U.S. Department of Labor, DFEC Central Mailroom, P.O.
Box 8300, London, KY 20742-8300.

What form do I submit to get reimbursed
for traveling to and from my medical appointments?

Complete the OWCP-957 “Medical Travel
Refund Request” form to request reimbursement for your
transportation/mileage expenses. This form is available online at
https://owcp.dol.acs-inc.com/portal/main.do –
click on the “Forms and Links” link.  Write your OWCP claim number on
the top right side of the form.  You may record 3 trips on each
form.  The section requiring a Doctor’s signature for each trip does
not apply to OWCP claimants.

Mail the completed OWCP-957 to:

U.S. Department of Labor
DFEC Central
Mailroom
PO Box 8300
London, KY 40742-8300

How do I get reimbursed for out of pocket
expenses I’ve paid for authorized treatments, pharmacy
expenses/medications, medical appliances, or medical supplies for a
work-related injury?

Reimbursement for pharmacy
expenses/medications, medical appliances and supplies, and medical,
surgical, and dental services can be claimed using Form OWCP-915 “Claimant
Medical Reimbursement Form”. This form is available online at https://owcp.dol.acs-inc.com/portal/main.do – click on
the “Forms and Links” link. Put each date of service on a separate line.
If you are requesting reimbursement for a co-pay, write “Co-Pay” in the
“Description of Charge” field. Use a separate form for each provider you
paid. Don’t mix prescriptions and office visits on the same form.

A reimbursement claim for medical
services, surgical services, medical appliances, or medical supplies must
be accompanied by a copy of the OWCP-1500/HCFA-1500 “Health Insurance
Claim Form” showing individual charges and signed by the medical Provider.
A reimbursement claim for dental services may be accompanied by a dental
version of the HCFA-1500 called the ADA 515 instead. While both of these
forms are available online (https://owcp.dol.acs-inc.com/portal/main.do – click on
the “Forms and Links” link), your medical Provider is very familiar with
them and maintains a supply. Your medical Provider must complete and sign
these forms.

A reimbursement claim for pharmacy
expenses/medications must be accompanied by a copy of the Universal Claim
Form or other pharmacy statement showing the name of the drug, NDC code,
quantity provided, cost, prescribing physician, and date the prescription
was filled.

All reimbursement requests must be
accompanied by proof of payment – a cash receipt, canceled check, or
credit card receipt.

Mail the completed OWCP-915 and related
documentation to:

U.S. Department of Labor
DFEC Central
Mailroom
PO Box 8300
London, KY 40742-8300

Be sure to include your claim number on
EVERY page you send.

I think I might need some help in using
the web portal at https://owcp.dol.acs-inc.com/portal/main.do. Do you have some instructions or a user
manual?

Yes. Go to https://owcp.dol.acs-inc.com/portal/main.do and click on the Help link (upper right
corner). This will open a User Guide.

What are the benefits of centralizing
medical authorizations and billing?

The new system is designed to allow our
contractor, ACS, to approve services and payments based on established
treatment guidelines and OWCP staff decisions regarding covered
conditions. In turn, this allows OWCP staff to dedicate more time to
entitlement issues and return to work efforts. We have made eligibility,
medical authorization, and billing information accessible 24 hours a day/7
days a week to Injured Workers, Employing Agencies, and Providers via the
Interactive Voice Response (IVR) system and the web. Providers can now
request, and for routine services receive, authorization on-line which is
easier for providers and speeds up the authorization process.

Why did you change to a toll number to
talk with a Customer Service Representative?

We offer an automated toll-free
Interactive Voice Response (IVR) system at 866-335-8319 which provides
access to information regarding eligibility, authorization, and bill
payment status. This information is also available online at https://owcp.dol.acs-inc.com/portal/main.do. A
great deal of information is available through the automated toll-free IVR
and web based processes which are available 24/7. All of these allow for a
greater savings to DFEC so that future enhancements can be implemented.

If you still have pressing questions, review Publication CA-550
"Questions and Answers About the
Federal Employees' Compensation Act"

If you would like to review the governing laws, click here for questions & answers from Title 20, US
Code.