Get Dol Owcp-1168 2023-2025

Filling out the DoL OWCP-1168 form online is a crucial step for providers looking to offer medical services for injured and ill workers. This guide will take you through each section of the form, ensuring that you provide the necessary information accurately and efficiently.

Follow the steps to successfully complete the DoL OWCP-1168 form.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Indicate whether you are applying for a new enrollment, updating your record, re-enrollment, or re-validation by selecting the appropriate option.
3. Complete Part A: Basic Information by selecting 'Enrollment Type' (Individual, Group Practice, Facility/Agency) and providing details like provider type and program choice.
4. Fill in your individual or organization information as applicable, including names, Social Security Number (SSN) or Federal Employer Identification Number (FEIN), and National Provider Identifier (NPI).
5. Proceed to Part B: Location Information. Provide complete contact information for your business location, including physical and mailing addresses.
6. In Part C: Taxonomy, list the taxonomy codes applicable to your services. Use additional sheets if necessary.
7. If applicable, fill out Part D: Ownership Details with the required organization or individual ownership information.
8. For individual and facility enrollments, move to Part E: License and Certification. Here, input the required licenses and certifications along with identification numbers and expiry dates.
9. Skip to Part F: Identifiers to enter any additional provider identifiers as needed.
10. In Part G: EDI Submission Method, select your billing methods, checking all relevant options based on your practice's submissions.
11. Complete Part H: EDI Submitter Details by providing information about your billing agent or clearinghouse if applicable.
12. Provide contact details in Part I: EDI Contact Details for any electronic data interchange contacts.
13. Review all entered information for accuracy, sign and date the form.
14. Finally, save your changes, and then download, print, or share the completed form as required.

Start filling out the DoL OWCP-1168 form online today to ensure your enrollment as a provider!