Justification for No material/Non-substantive Change
OWCP 1500 Health Insurance Claim Form (OMB No. 1240-0044)
Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.
The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is the agency responsible for administration of the Federal Employees’ Compensation Act (FECA), 5 U.S.C. 8101 et. seq., the Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et. seq. and the Energy Employees’ Occupational Illness Compensation Program Act of 2000 (EEOICPA), 42 U.S.C. 7384 et. seq. These statutes require OWCP to pay for appropriate medical and vocational rehabilitation services provided to beneficiaries. For OWCP’s bill processing contractor to pay medical providers for physician and professional services, providers must submit an OWCP-1500, Health Insurance Claim Form which is completed to identify a Patient’s demographic information, a Patient’s insurance information, Medical Codes, and Dates of service.
OWCP is in the process of implementing changes to the bill processing system to utilize providers NPI numbers and Taxonomy codes to ensure that the provider that is billing for payment of medical services is eligible to perform the billed services. The National Provider Identifier (NPI) is a unique identification number for covered health care providers, created to help send health information electronically more quickly and effectively. The Taxonomy code is a unique 10-character code that designates your classification and specialization. Both are integral for the new bill processing changes.
This change will also better align the OWCP with CMS and other industry standards for bill processing. OWCP is requesting to make changes to the instructions for Item 24j and Item 33(a and b); on page 3 of the OWCP 1500 Form to update the instructions language regarding the NPI number and corresponding Taxonomy code for All OWCP Programs. Currently OWCP requires only FECA providers to enter the NPI number for Item 24j and Item 33 should be entered by the Provider. Therefore, we are requesting to update both Items respectively.
If the provider does not provide their NPI number and Taxonomy code upon bill submission, the bill processing contractor will be unable to verify that the provider submitting the bill for payment is eligible to perform the services rendered to the OWCP claimant. Additionally, since the bill processing system will be enhanced to require the NPI number and Taxonomy code, if the provider does not enter the numbers, then the omission will result in delayed payment for services rendered and will substantially prolong and increase the burden on providers to receive payment for services rendered.
The regulations implementing the above statutes that OWCP administers permit the collection of information necessary to allow its billing contractor to process and pay bills submitted by providers of medical and vocational rehabilitation services. (20 CFR 10.801, 30.701, 725.704, 725.705 and 725.714).
We recognize that the expiration date for the form is 6/30/2024 and will need to take appropriate actions for update. However, the revision for expiration is not requested currently because approval of this request is needed by no later than January 15, 2024, and due to time constraints there is not enough time to allow for the process regarding the Form date update. By obtaining OMB clearance/approval by January 15, 2024, this will alleviate delayed payment to providers for services rendered to OWCP beneficiaries. Any approval date beyond January 15, 2024, may result in delayed payment to medical providers and phone calls to OWCP Programs regarding the pending bill processing system changes.
Requested Changes to Instructions - Item 24j and Item 33(a/b):
Current Instructions: Column 24J: Enter NPI. For FECA: required. OMISSION WILL RESULT IN DELAYED BILL PROCESSING.
New Instructions: Recommended New Instructions: Column 24J: Enter the Taxonomy code in the shaded area of the field. Enter the NPI number in the unshaded area of the field. When NPI is entered, taxonomy is required and, vice versa. Required: Enter the servicing NPI for group providers.
Current Instructions: 33a/b
33a: Enter NPI.
33b: Enter taxonomy number.
New Instructions: 33a/b
Item 33a. Required- Enter billing provider NPI. OMISSION WILL RESULT IN DELAYED BILL PROCESSING.
Item 33b. Required- Enter billing provider taxonomy. OMISSION WILL RESULT IN DELAYED BILL PROCESSING.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Su, Amy T - OWCP |
| File Modified | 0000-00-00 |
| File Created | 2024-07-20 |