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
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.
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 60 days for medical and over 120 days for pharmacy) the account will transfer to 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
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.
OPTION TO RETURN OVERPAYMENTS THAT HAVE BEEN REFERRED TO TREASURY THROUGH PAY.GOV
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 via Pay.gov. Providers will access the site, https://pay.gov/public/accesscode/, and enter an access code provided in the debt letter received from CRS. This provides the ability to make an on-line payment 24-hours a day, 7-days a week using a checking/savings account or credit card at the secure Pay.gov website.
Pay.gov Frequent Asked Questions:
Q: What is Pay.gov?
A: Pay.gov is operated by the U.S. Department of the Treasury and is a web-based application that allows you to make online payments to government agencies.
Q: I'm not comfortable with making payments online. Can I mail in my payment or pay over the phone?
A: DEEOIC does not accept payments made by mail. However, CRS provides several payment options including an option to pay by phone. Refer to the CRS Demand Letter’s Payment Options section for more information or call CRS directly at 855-496-2708.
Q: Is Pay.gov secure?
A: Yes. Pay.gov uses 128-bit SSL encryption to protect your transaction information while you're logged in to Pay.gov. In addition, any account numbers you set up in your profile are encrypted before being stored in the Pay.gov database. When you access your profile, any account numbers you entered will be masked on-screen; each account number in your profile will be displayed as a group of asterisks followed by the last four digits of the account number.
Q: What is an "ACH" payment?
A: ACH stands for "Automated Clearing House" and refers to an electronic debit from a checking or savings account, commonly known as a direct debit. This option requires you to enter your routing and account number.
Q: How quickly is my ACH payment processed?
A: Your ACH payment will be posted within five days, after submission.
Q: What is the payment processing schedule for Pay.gov?
A: The Pay.gov site is available 24 hours a day, 7 days a week (holidays included) for users to submit payments, with the exception of a maintenance window every Sunday from 2:00 AM to 6:00 AM Eastern Standard Time. ACH payment processing follows the Federal Reserve holiday schedule; The holiday schedule can be found on the web at https://www.federalreserve.gov/aboutthefed/k8.htm
Q: How do I know my payment was successful?
A: At the end of submitting your payment, you will see a confirmation screen indicating your payment was successful. This confirmation screen is your receipt and should be printed for your records. You will also receive a copy of this receipt in your email account if you provided an email address along with your bank account information.
Q: How will the transaction appear on my bank statement?
A: Pay.gov transactions will usually appear with the description “DEEOIC PAYMENT”. If you're not sure what a particular payment is, the first point of contact should be your financial institution. They should be able to assist you in verifying where your payments were sent.
Q: I used the wrong agency form to make a payment, how do I correct it?
A: Contact Pay.gov Customer Support at: email@example.com or by phone, 800-624-1373 (toll free, select Option #2).