Re: [owcp] Prescription format
- Thanks Nancy, I appreciate your response. I'm going to muddle through and see what happens.----- Original Message -----From: FourDirect@...Sent: Sunday, April 25, 2004 6:43 PMSubject: Re: [owcp] Prescription formatWelcome to the group!
Unfortunately, I am unable to be of much help. Does anyone else out there have ideas for this person? In fact, I've had a lot of difficulty for the past 4 or so years since the USDOL/OWCP has been using "Working RX" out of Salt Lake City to "approve" Rx's. I recently investigated the issue regarding my trying to get three simple medications covered for my PC illness - medications that had always been paid in the past, and learned that since ACS has taken over billing that "Working Rx" has lost millions of dollars in not getting paid by ACS (they took over the billing and reimbursement as of Sept. 1, 2003, I believe.) So, I took don't know where to go to have the prescription issue resolved.
Does anyone know about this? When I repeatedly mail the Rx along with letters of justification to my claims examiner they seem to sink into the great abyss.
I wonder if mobility devices are also approved in a similar manner as other prescriptions.
Anyone have any ideas?
[Aside to the group: Having gotten no where with Hillary Clinton's office I finally went to my other US Senator in NY, Charles Schumer, and within a day his office did respond and will start investigating my issues. I will bring the Rx problem to their attention and will let everyone know if I find a magic solution. Is everyone still out there? I'm feeling a little alone!]
Hi all. This is my first post. I sustained orthopedic injuries while
a volunteer in India-109 in 1971. For the last 20 years my physician
has just written "Rx rt leg prosthesis" on his office prescription
pad and OWCP has approved the prosthetic device and paid the maker.
Beginning about four years ago they stopped approving the device
with no explanation. My mobility device is now in the shop and the
vendor says that the order form the physician needs to be more
elaborate, including type of injury and preferred vendor. Does
anyone know of a specific form the MD can fill out for pre-approval
or any other guidelines for replacing/repairing hardware I should
pass on to my physician?
ACS does it all now. There are people who have received approval for Tempurpedic beds when prescribed by their doctor.
Go to the FECA, then claimants section on the left side of the above page.
This is the page that has all the ACS contact info:
Prescription Benefits and Processing questions:
See, I've faxed and mailed all of my requests many times to my OWCP claims examiner and I have the sense that she/they first need to actually approve new Rx's and medical treatment. Are you actually saying that now ACS does the approving? Do I just bypass the USDOL/OWCP claims people that I used to fax to and fax directly to ACS? It would be worth my buying my own fax machine, if that's the case as my medical team always asks me to do the actual sending in of material anyway.
Then, does ACS still go through "Working Rx" in Salt Lake City? In other words, how will my pharmacy know if my prescriptions have been approved. In the past, they are filled and given to me and they either are or aren't covered and if not, I'm stuck with a huge bill. How does the approval actually get to the pharmacy? And how do I actually know if a new procedure has been approved so that I can go ahead and make an appointment?
Thanks for your ongoing advice. I did just learn that all providers, in order to get paid, must now "enroll" with ACS. I've been getting some of my providers to do so and then have faxed them in for them.
Use the following link to see for yourself. I have also pasted the page to this email.
Click here: Government Guide: http://www.governmentguide.com/ams/clickThruRedirect.adp?55076483,16920155,http://www.dol.gov
April 26, 2004 DOL Home > ESA > OWCP > DFEC Home Page > Consolidated Bill Processing and Medical Authorization System
Information on FECA's Consolidated Bill Processing and Medical Authorization SystemThe Federal Employees’ Compensation (FEC) division of OWCP consolidated its medical authorization and bill payment processes on September 2, 2003. All Medical Authorizations and Bill processing are now handled by our private contractor, ACS. For medical authorizations and billing and/or reimbursement questions, please call 866-335-8319, Monday – Friday, 8am – 8pm, EST. Providers may fax urgent medical authorization requests to 800-215-4901. All mail and bills for Federal workers’ compensation cases should be sent to:
U.S. Department of Labor
DFEC Central Mailroom
PO Box 8300
London, KY 40742-8300
These changes allow us to serve you more efficiently. We thank you for your cooperation.Information for Injured Workers Information for Medical Providers Information for Employers
Why are your medical providers telling you to send everything? That is the cost of doing business!!! However, it does give you the advantage of seeing everything that is sent, before it is sent. Especially if there is an error, you can get your doctor to correct it before it becomes an issue you have to fight. So I would get a fax to send everything.
What is "Working Rx" in Salt Lake City? If it is a pharmacy they should know how to bill for worker's comp. As for approving prescriptions-each accepted claim has a list of drugs that is approved, or acceptable for the 'injury.' Use this link:
NEW! YOU CAN NOW DETERMINE IF A MEDICAL SERVICE IS COVERED FOR AN INJURED WORKER OR REQUIRES PRIOR AUTHORIZATION WITHOUT LOGGING INTO THE MAIN SITE.Eligibility Inquiry is now available to users without requiring login. You may inquire on a FECA claimant's eligibility for a medical service from any page by selecting the Eligibility Inquiry option from the left navigation menu. Note that eligibility data is still encrypted for the protection of confidential information.
This site, and the one in my previous email should answer your questions.
Thanks. I'm looking into it all. I've had such a hard time finding a pharmacy that will even work with the USDOL that I am still going through my pharmacy in AZ three years after I moved to NY as I haven't found anyone here willing to deal with them and this place in AZ is willing to work with Working Rx. I have a complicated complex set of illnesses and sequelae of symptoms that nothing of mine has ever fit neatly on a form or a line.
I've also never had a doctor or provider either in NY or in AZ who has had the knowledge or the willingness to write the materials necessary or to even bill the government. I'd have been dead a long time ago had I depended on them. Since rarely has it taken fewer than 11 or so submissions to get anything paid, I don't blame the health care folks for being unwilling to devote that kind of time but I certainly do pay the price. It's tough with a complex and complicated set of illnesses.
So, I'm having a flareup again this week but will check out your website information right now.
Hum, I wasn't able to find out how to actually know what I need to send ACS. I got such confused information from them last week on the phone. I think that my situation must be more complicated than yours. Prior to ACS taking over the Working Rx was the management company that the USDOL had hired in Utah to determine what prescriptions would be approved or denied. They took over about 4 years ago and the pharmacies billed them after the OWCP regional office would sign off or not sign off on approving prescriptions. ACS must be using a different system now but I was unable to find out what is coverered and I'm trying to petition for 3 meds to be covered for "non-traditional" uses and need to know if these letters of rationale go to my claims examiner or to ACS.
I'll keep muddling..... And on it seems to always go.
ACS is apparently approving different coding numbers for treatments now, too. The physical therapy codes that used to be covered are now rejected and I've had to borrow a lot of money to continue treatment only to find out that they're all denied retroactively. Do others have this problem?
We just keep resubmitting bills with various codes hoping that something will hit the target!!! Hard way to function.
Kevin, have you had this problem? Others out there? I had finally gotten it down once London, KY took over prior to ACS and now it seems to be a struggle all over again.
Laurie, I really do appreciate your ongoing help.
Check out www.fedworkerscomp.net
It's the most info in one place to help us anywhere.
You may also subscribe to the list & ask questions.
Different people have had widely differing experiences with ACS. My
one contact with them was so frustrating that I don't intend to
contact them unless I really have to. What I was told by ACS is
that they don't have the authority to approve anything. Rather I
was informed that they administer only what has been approved by my
claims examiner. Apparently in my case, they have been told which
diagnosis (ICD-9) and procedure (CPT) codes are acceptable. If my
doctor submits something outside of the "acceptable," ACS has no
authority to do anything except to reject them. Of course, as a
claimant, the only way to find out what's acceptable is by trial and
error. No one (i.e., neither ACS nor OWCP) will provide much
information to guide you.
Some of what's acceptable doesn't even make sense. For example, in
my case, the only ICD-9 codes that ACS will accept are 493 or 493.00.
My doctor used 493.0 for years, but that will automatically reject
from ACS' system even though it's a perfectly legitimate code.
Furthermore, ACS isn't consistent. The last 6 bills that I've
submitted for reimbursement have been filled out exactly the same
way by my doctor. One was paid in full; two were not paid at all;
and three were partially paid. Go figure!
My caseworker in Congressman Bass' office won't deal with ACS
either, preferring to contact OWCP directly.
--- In firstname.lastname@example.org, FourDirect@a... wrote:
> ACS is apparently approving different coding numbers for
treatments now, too.
> The physical therapy codes that used to be covered are now
rejected and I've
> had to borrow a lot of money to continue treatment only to find
> they're all denied retroactively. Do others have this problem?
> We just keep resubmitting bills with various codes hoping that
> hit the target!!! Hard way to function.
> Kevin, have you had this problem? Others out there? I had finally
> down once London, KY took over prior to ACS and now it seems to be
> all over again... Nancy