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Get Dol Owcp-1168 2004
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How to fill out the DoL OWCP-1168 online
Filling out the DoL OWCP-1168 form is an essential step for medical providers seeking enrollment or updating their records within the Office of Workers' Compensation Programs. This guide provides clear instructions to help users complete the form efficiently and accurately.
Follow the steps to complete the DoL OWCP-1168 effectively.
- Press the 'Get Form' button to access the DoL OWCP-1168 form and open it in your preferred editor.
- Indicate whether you are applying for a new enrollment or updating an existing record by selecting the appropriate option and entering your Provider Number or EIN if necessary.
- Input the earliest date you treated a participant in any OWCP program. This helps establish your practices' history with the program.
- Provide your practice information, including the name, address, city, state, zip code, telephone number, and FAX number. Ensure all details are accurate for seamless communication.
- Select the type of practice: Individual, Facility, or Group. Complete the necessary fields based on your chosen type.
- Complete the Provider Type section by filling in the Provider Type Code and the Provider Type itself. If you select 'Other Provider' or 'Non-Medical Vendor,' provide a brief explanation.
- Enter your Tax ID or Social Security Number as required. If you are a hospital, input your Medicare Number as well.
- For Individual providers (M.D.s and D.O.s), fill in your name, license number, state of licensure, current licensure expiration date, specialty code(s), and certification expiration date.
- If you are a member of the UMWA Health & Retirement Funds, include your member number.
- Provide your billing address, indicating 'same' if it is identical to your practice address. Confirm if you have completed a form for Electronic Funds Transfer (EFT) and if you are interested in electronic billing.
- Review all entries for accuracy before signing the form. Ensure that the provider or representative's signature and date are included.
- Finally, save your changes, and opt to download, print, or share the completed form as needed.
Complete your DoL OWCP-1168 form online today to ensure your enrollment is processed without delay.
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The OWCP provides compensation and insurance for federal employees who suffer work-related injuries. This coverage, known as the DoL OWCP-1168, ensures medical benefits and wage loss payments for eligible workers. Understanding how this insurance works can help you navigate claims and receive the necessary support for recovery.
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