OWCP Basic Training - 15th Annual Federal Workers ...

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Auth Requests will be returnedif:‣ The case is closed‣ The claimant’s casenumber is missingor invalid‣ Procedures codesare missing orinvalid‣ Any of the followingare missing:‣ Prescription, whenrequired‣ Rental or PurchasePrice, when required‣ Frequency andDuration
No Authorization• Certain procedures require prior authorization• ACS requires specific information in order tocorrectly process auth requests• Examples: claimant case #, provider #, CPT codeand date range if available• If auth was not previously requested, a retroauthorizationmay be requested• Provider will need to request that the denied billreprocessed by ACS• This is also the case if an authorization haspreviously been denied. Once the authorization isapproved you may call the call center to have the billadjusted or resubmit the bill
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OWCP Basic Training
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OWCP Structure and JurisdictionThe
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Information and RecordsIndividual c
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PenaltiesThe regulations set forth
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Program BenefitsFECA provides for f
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Compensation BenefitsFederal employ
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Compensation for Loss of WagesThe A
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Schedule AwardThe Act provides for
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Other BenefitsAttendant AllowanceUn
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Federal WorkersCompensationoClaims
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Traumatic Injuries (CA-1• Back st
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Agency Processing of Traumatic Inju
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Tips for CA-1 Form Completion- Agen
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Form CA-16• Only used in Traumati
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Form CA-16 Instructions cont.
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Occupational Diseases (Form CA-2)OW
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Agency Processing of an Occupationa
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Recurrence of Disability Cont.It do
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Form CA-2a Notice of Recurrence
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What if the wrong form issubmitted?
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Form CA-7 Claim for Compensation
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Form CA-7b Leave Buy Back
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The Basic Elements of a Claim
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Statements/Comments• In cases inv
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A note about property vs.premises (
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Pre-existing existing Conditions•
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Three Statutory ExclusionsWillful M
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Three Statutory ExclusionsIntoxicat
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Withdrawal of a Claim
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Continuation of Pay
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Continuation of Pay (COP)The 1974 a
Page 69 and 70: Controverting COP vs.Challenging th
Page 71 and 72: 9 Reasons an Agency May Controvert
Page 73 and 74: CONTROVERTING COP (CONT’D)OTHER R
Page 75 and 76: INVESTIGATING ENTITLEMENT TO COP
Page 77 and 78: INVESTIGATIONS (CONT’D)SUBMIT OBJ
Page 79 and 80: INVESTIGATIONS (CONT’D)CREDIBLE W
Page 81 and 82: INVESTIGATIONS (CONT’D)Providing
Page 84: “NO TIME LOST” (NTL) CASES ANDC
Page 87 and 88: COUNTING COP DAYS
Page 89 and 90: Portion of DayIf the employee stops
Page 91 and 92: End of PeriodThe claimant's entitle
Page 93 and 94: Counting COP Entitlement - Example
Page 95 and 96: RETURNING INJURED EMPLOYEES TO MODI
Page 97 and 98: Requesting Medical ReportsA. The fi
Page 99 and 100: Weight of Medical EvidenceWhen OWCP
Page 101 and 102: Preparing the Job OfferHowever, if
Page 103 and 104: Suitable OffersTo find an offer of
Page 105 and 106: Disqualifying FactorsVerify that no
Page 107 and 108: What to do when a job offer is vali
Page 109 and 110: If the reasons for refusal are not
Page 111 and 112: Moving ExpensesMoving Expenses and
Page 113 and 114: AUTHORIZATION LEVELS• LEVEL 1: Pr
Page 115 and 116: What requires authorization?• Whe
Page 117 and 118: Info Required for Auth Requests:Rou
Page 119: Info Required for DME Auth• Claim
Page 123 and 124: Authorization EOB Code• Your clai
Page 125 and 126: Authorization Approval• If a requ
Page 127 and 128: AUTHORIZATION LETTER
Page 129 and 130: Medical Bill Processing
Page 131 and 132: Claimant Eligibilityibilit• Each
Page 133 and 134: Treatment t Suite• Services that
Page 135 and 136: Unreported Earnings or ActivitiesFo
Page 137 and 138: The Road to ForfeitureIf the employ
Page 139 and 140: Evidence Required to Establish Forf
Page 141 and 142: Administrative ActionsOnce the offi
Page 143 and 144: Other ECAB cases…..• The Office
Page 145 and 146: Office Decision Affirmed• The Boa
Page 147 and 148: Office Decision Affirmed• Appella
Page 149 and 150: Cases that do NOT lead to Forfeitur
Page 151 and 152: FECA Fraudand Criminal Prosecution
Page 153 and 154: §8148 Forfeiture of benefits by co
Page 155 and 156: 18 U.S.C. 1920"§1920. False statem
Page 157 and 158: Pretrial DiversionDuring pretrial d
Page 159 and 160: FECA Program Highlightsht‣Electro
Page 161 and 162: CA-7 and CA-3 3e-Filing‣ Effectiv
Page 163 and 164: Overview• Forms to be filed via A
Page 165 and 166: Benefits of E-filing‣ Early recei
Page 167 and 168: How Will the ICS E-file forms?•Th
Page 169 and 170: What the ICS will seeICS willcomple
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How will the ICS know it worked?In
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Major Differences Web form vs. Pape
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Fields onCA-7aPre-Populated Populat
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RequiredFields on CA-3Pre-Populated
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CQS - Claimant Query SystemCQS will
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CQS case summary and status will di
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Description:DFEC Centralized IVRThe
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IVR Continued‣ Reduced staff work
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COP/RTW Redesign Features‣ COP As
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