Wiki Dealing with US Department of Labor for Worker's Comp claims

dcandello

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Hi Everybody,

I code for 6 clinics in Oregon that primarily deal with worker's comp insurance and I deal with a lot of WC insurance such SAIF, Sedgwick, Gallagher Bassett, Travelers, Broadspire, Corvel, Matrix, etc. We also bill to US Department of Labor as well but I've been having a difficult time getting paid by them. Can anyone who has dealt with them give me some pointers on how to deal with them/get paid or at least how I submit appeals or disputes to get paid? I know they are a federal WC insurance so they are not under the state's jurisdiction. I even have trouble getting a claim/case file number from USDL as they state they cannot give out that information/refuse to give that info out. Any help would be great!
 
First off, get your listed provider number assigned from DOL to your provider's Tax ID. Once you have that, see if you can log in or create a log-in to the federal portal. Once you have access, you can check eligibility for WC claims and also obtain documents for adjustments (the Federal name for claim correction submission form).

Peace
@_*
It's your resource for Federal claims. There is a training portion there on the left side of the page. Also, each office visit with the approved provider on Federal WC claims requires a Federal Report which is analogous to the PR2 forms that you submit for other WC carriers. Good luck.

https://owcpmed.dol.gov/portal/main.do
 
Concerning the case file, the patient has to have that information to go seek a provider since they have spoken with an adjustor on the DOL end to even have a claim/case approved. I'd be leery of accepting a patient without that sort of information. It would be akin to a patient walking in and saying they have a PPO Anthem BX plan and scribble down the info and the office doesn't verify the information online or through the phone before seeing the patient.

Peace
@_*
 
I know I'm late in responding but I wanted to thank everyone for their responses to this, it helped a great deal :) I wanted to also ask if any one knows if there is a form that we need the patient's to fill in order for us to release records (the return to work status) to the employer with USDL? In Oregon, patients fill out what is called an 827 and that gives the authorization but since USDL is a federal WC carrier they don't recognize the 827. Am I correct in assuming that when the patient fills out a CA-1 or CA-2 form at their place of employment, that we need a copy of that completed form so that we have our "records release" on file for the patient?
 
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