This page contains numerous resources for medical providers. Each tab will give you access to frequently used forms, portals, and templates in one easily accessible location. Forms should be submitted using the same guidelines previously used.
A Division of Energy Employees Occupational Illness Compensation (DEEOIC) covered employee must first complete Form EE-17A, Claim for Home Health Care, Nursing Home, or Assisted Living Benefits, identifying his/her treating physician. Upon receipt of the completed EE-17A, the DEEOIC will issue Form EE-17B, Physician’s Certification of Medical Necessity under the EEOICPA directly to the employee’s treating physician. The EE-17B form must be completed by the treating physician that is responsible for providing care related to the covered employee’s accepted work-related condition(s). This form is recommended for use with initial authorization and reauthorization requests.
**Please Note: The EE-17B form must be completed in its entirety and returned to the DEEOIC along with all applicable medical documentation. Missing or incomplete information may result in processing delays.**
Step 1: Complete the EE-17B form in its entirety, titled, “Physician’s Certification of Medical Necessity under the Energy Employees Occupational Illness Compensation Program Act.”
Step 2: Use Blue or Black Ink only. Write clearly and within the boxes provided. Please completed all sections of the form. Missing or incomplete information may result in processing delays.
Step 3: Patient Information: Enter employee’s information and have patient provide you with their DEEOIC Case ID number.
Step 4: Treating Physician: Complete your information
Step 5: DEEOIC Accepted Conditions: Enter the ICD-10 code and description for the DEEOIC accepted condition(s) for which care is being prescribed.
Step 6: Date of Physician Examination, and Request for Assessment or Letter of Medical Necessity: Indicate the date of the physical examination, and select the appropriate box.
Step 7: Physician Declaration: Signature and date are required.
Step 8: Additional Instructions to Physician: Please read the additional instructions provided carefully and provide all supporting documentation necessary to support the medical necessity of the request.
Step 9: The quickest way to submit the form is to upload it to the Energy Document Portal. You can also submit claim forms through the Resource Centers or the District Offices, via U.S. mail or fax. There are total of 11 Resource Centers located across the country that are equipped to assist claimants either in person or over the phone.
Medical Provider Enrollment
Qualified Medical Providers are encouraged to enroll. DEEOIC can only process bills from providers who have enrolled. For enrollment information, please visit the Medical Bill Processing Website at http://owcpmed.dol.gov. This link will take you to the forms necessary for enrollment. You can complete enrollment on line or by mail. Once you enroll, you will have access to medical bill status, payment status, enrollment status and medical authorization status.
EEOICP Medical Bill Operations
Telephone: 1-866-272-2682
Hours of Operation: Monday through Friday, 8:00 AM to 8:00 PM (EST.)
Medical Bill Processing Address:
U.S. Department of Labor OWCP/DEEOIC
P.O. Box 8304
London, KY 40742-8304
Medical Bill Provider Enrollment Documents:
- Provider Enrollment Form and Instructions
- Helpful Hints for Billing
- EFT (ACH) Vendor Payment Form and Instructions
- EDI Enrollment Form
Information regarding Home and Residential Health Care Authorized Billing Codes, can be found in the Federal Energy Employees Occupational Illness Compensation Program Act (EEOICPA) Procedure Manual by clicking this link.
For authorized billing codes relevant to the level and duration of care, please see Exhibit 30-4. A direct link to that exhibit can be found in Section 12 of Chapter 30 – Home and Residential Health Care.
For information on how to bill for Home Health Care services, please review our Home Health Care Billing fact sheet.
The Division of Energy Employees Occupational Illness Compensation (DEEOIC) does not accept payments made by mail. All providers must submit an adjustment (corrected bill) or a point-of-sale reversal to ensure that the overpayment created is properly reflected as an account receivable by DEEOIC. Once the account receivable is established, providers will receive a debt letter and instructions on how to service the account receivable from the Treasury’s Centralized Receivables Service (CRS). CRS helps federal agencies collect money that individuals, businesses, and states owe the agency (accounts receivable). CRS focuses on collecting money when it is first due or only slightly overdue before the account is considered delinquent. Once a debt is delinquent (Over 120 days), the account will transfer to U.S. Department of the Treasury’s Cross-Servicing program for additional collection activity.
PROCESS FOR SUBMITTING A CORRECTED CLAIM
Medical providers can submit a corrected claim by accessing the Workers’ Compensation Medical Bill Processing (WCMBP) website at: https://owcpmed.dol.gov/portal/resources/forms-and-references/general. The Bill Adjustment Request Form should be downloaded, completed, and mailed with the corrected claim and any supporting documentation to:
U.S. Department of Labor OWCP/DEEOIC
P.O. Box 8304
London, KY 40742-8304
Or
Medical providers can log into the WCMBP System and submit an adjustment/corrected claim through the online portal.
- Access website at: https://owcpmed.dol.gov/portal/provider/provider-login
- Select bill adjustment/void link under “Bills”
- Locate the Transaction Control Number (TCN) to adjust
- Make necessary corrections
- Add attachments, if applicable and submit
Pharmacy providers can submit reversals in their point-of-sale system if a claimant fails to pick up their medication.
OPTIONS TO RETURN OVERPAYMENTS THAT HAVE BEEN REFERRED TO TREASURY
Once an overpayment has been referred to Treasury for collections, providers will receive a debt letter from CRS with instructions on how to submit payment. You will have the following options to make full payment of the amount due:
Payment by Internet: Make an on-line payment 24 hours a day/7 days a week using your checking/savings account or credit/debit card at the CRS Guest Payment website: https://crsportal.fiscal.treasury.gov/
Payment by Phone: Make a payment by calling 1-888-618-3103 between the hours of 8 AM and 8 PM Eastern Time, Monday through Friday, excluding Holidays. Please have your checking/savings account or credit card information available before calling.
Payment by ACH Credit: Make an Automated Clearing House (ACH) payment through your financial institution. Payments by ACH must be submitted no later than the day before payment is due.
Payment by Wire Transfer: Make an immediate payment through your financial institution via the Federal Reserve Bank’s Fedwire system.
You may also contact the Centralized Receivables Service at 1-888-618-3103 with any questions about your invoice(s) or available payment options.