Justification for No material/Non-substantive Change
OWCP 04 Uniform Health Insurance Claim Form (OMB No. 1240-0019)
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 institutional facility services, providers must submit an OWCP-04, Uniform Health Insurance Claim Form which is completed to include all data necessary for processing of the claim.
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 Block 76 – Attending provider NPI, ID, qualifiers, and last and first name; Block 81 (81CC-a: billing provider taxonomy and Block 81CC-b: attending provider taxonomy); and Block 56 - NPI number of the facility, on page 4 of the OWCP 04 Form to update the instructions language to require that All providers enter provider NPI and Taxonomy. Currently the blocks are not required.
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).
Approval of this request is needed by no later than 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 –
Current Instructions: Block 56- Type or print the NPI number of the facility.
New Instructions: Recommended New Instructions. Block 56- Required. Enter Billing provider NPI.
Block 76- Attending provider NPI, ID, qualifiers, and last and first name
Current Instructions: Block 76 Not required.
New Instructions: Recommended New Instructions: Block 76: Enter Attending provider NPI. When attending NPI is entered, attending taxonomy is required in Block 81CCb and, vice versa.
Block 81- Taxonomy code and qualifier
Current Instructions: Block 81 Not required.
New Instructions: Recommended New Instructions:
Block 81CCa: Required. Enter Taxonomy code for the billing provider. OMISSION WILL RESULT IN DELAYED BILL PROCESSING.
Block 81CCb: Enter Taxonomy code for the attending provider. When attending taxonomy is entered, attending NPI is required in Block 76 and, vice versa.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Su, Amy T - OWCP |
| File Modified | 0000-00-00 |
| File Created | 2024-07-24 |