ACS-DOL
Bill Automated
Adjustments Process
for FECA Providers
2010
Systematic Recoupment of
overpayment
1
Table of Contents
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What is the new process?
How will the change affect me as a provider?
How do I complete the template?
What is considered an adjustment request?
How do I request an adjustment?
How do I submit an adjustment request?
When can I expect a response after submitting a request?
What if I don’t know the status after 10 business days?
Systematic Recoupment of Overpayments
Payment
Refund
What if I have not received payment?
Return to Provider (RTP)
Appendix A: Definitions
Appendix B: FAQ page for easy access and printing
Appendix C: Helpful Links
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What is the new process?
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The new process requires the use of an adjustment
template to more readily identify adjustment requests
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The new process allows for the automatic recovery of
overpayments from weekly payments.
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The automated adjustments process will provide:
 Faster, more efficient processing
 Systematic notification of credit balance owed to DOL
 Automated adjustment processing upon receipt of
request
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How will the change affect me
as a provider?
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The new automated adjustments process will
only affect OWCP FECA Providers
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As a FECA provider, when a bill is submitted
requesting adjustment processing, the
provider will make the request using the new
adjustment template
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How do I complete the template?
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Box 1 – Enter the 17 digit
TCN of the bill to be
adjusted
Box 2 – Enter the 9 digit
claimant ID number and the
claimant’s name
Box 3 – Enter the provider
name, address, 9 digit ACS
Provider ID number, phone
number, and name of a
contact person
Box 4 – Check the reason
for adjustment
Box 5 – Enter the
explanation for adjustment
Provider signature and date
is required for processing
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How do I complete the
template?
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Complete all fields on the template
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To ensure correct processing, please complete one
template for each bill to be adjusted
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If information is missing or invalid, the request may be
returned to provider (RTP’d).
Do not add multiple case numbers or TCNs to one
document. Each request is matched to an original TCN to
ensure accuracy.
You may indicate “See Attached” in the “Explanation
of Adjustments” field
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Supporting Documentation
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Supporting documentation is required
Adjustment requests must be submitted with a corrected bill
(preferred) or an RV indicating TCN to be adjusted
Bill should include verbiage such as “corrected bill,”
“reconsideration,” or “adjustment”
If submitting an RV, please note that only the TCN included
on the template will be adjusted with each request
Note: if a bill is submitted with Corrected Claim verbiage
without the adjustment template, the bill will be processed
as a new day bill, not as an adjustment request.
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Supporting Documentation
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Submit additional documentation as necessary
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E.g. manufacturer’s invoice for implants or supplies,
operative reports, and/or admission and discharge
summaries, etc., to support justification for applicable
procedures/services billed.
8
What is considered an
adjustment request?
An adjustment request is a correction, change or
update to a bill. Adjustment request can occur for
the following examples :
 Payment consideration for a partially paid bill
 Payment consideration for a previously denied bill
 General corrections to a previously submitted bill
(ex. CPT Code changes, incorrect case number)
 An Authorization is now on file
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What is considered an adjustment
request (continued)?
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Timely filing along with proof of timely filing
Claimant eligibility or treatment suite issues
Requesting reprocessing for duplicate denials
Submittal of additional documentation
Implants payment- along with proof of
purchase and/or manufacturer’s invoice
10
What’s the difference between
an appeal vs. an adjustment?
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An adjustment is a request to correct, change or update previously billed
information.
An appeal is a request to review and re-consider the amount paid per the
OWCP fee schedule, based on the following criteria:
 The billed amount is based on the complexity of the service/procedure
performed
 The presence of a severe medical condition made treatment especially
difficult
 The provider possesses unusual qualifications (i.e. additional
qualifications beyond Board certification in a medical specialty, such as
professional rank or published articles)
If you would like to submit an appeal, please submit:
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the bill with the word “Appeal” clearly indicated
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the written reason for requesting a review of the amount paid
Note: an adjustment template is NOT required for an appeal
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How do I request an adjustment?
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FECA providers must request adjustment using the appropriate template
 This template does not apply:
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Pharmacies (submitting transactions via POS or Tape transmissions)
DOL-contracted providers (Contract Nurses, Voc Rehab, and SECOP Providers)
Providers for the DEEOIC (Energy) Program
Providers for the DCMWC (Black Lung) Program
To obtain and/or retrieve the adjustment template:
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Download the FECA Adjustments request template from the ACS-DOL Web
Portal http://owcp.dol.acs-inc.com/portal/formsAndLinks.do
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Adjustment requests coming directly through the ACS-DOL Call Center
(844) 493-1966 will be redirected to utilize the web site with the exception of an
adjustment request due to authorization now on file
If you cannot download the template from the Web Portal, please call our
call center and request a document to be faxed to you.
DOL Welcome Packets for newly enrolled providers will also include
copies of the template
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How do I submit an adjustment
request?
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Mail the template along with your corrected bill
and/or other attachment (s) to :
DFEC Mailroom
P.O. Box 8300
London, KY 40742-8300
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When can I expect a response
after submitting a request?
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Adjustment request submitted by providers are sent to
London KY. Once received, providers can/will:
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Receive bill payment status within 10-business days
from date of receipt.
Receive an RTP (return to provider for additional
information ) letter within 10-business days from date
of receipt in London, Kentucky mailroom.
Have the ability to check bill status on the Web
http://owcp.dol.acs-inc.com or ACS IVR 1-866-3358319
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You can call the ACS Call Center at (844) 493-1966 Monday
- Friday 8 a.m. to 8 p.m. EST for any additional information
or assistance
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When can I expect a response after
submitting a request (continued)?
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Web http://owcp.dol.acs-inc.com
 To check your bill status online, you must have a user
ID and password to access the secure portal. If you do
not have an account, please register as a user by
clicking here.
IVR (Interactive Voice Response) 24/7 access
1-866-335-8319
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Review the Remittance Voucher (RV) online
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Select Payment Status page on the Web Portal inquiry
menu
123123
321321
231231
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What if I don’t receive a response
after 10 business days?
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Call the ACS/IVR system at 1-866-335-8319
Check bill status on the Web Portal
Call the ACS Call Center at (844) 493-1966
Monday - Friday 8 a.m. to 8 p.m. EST
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Systematic recoupment of overpayments
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Systematic recoupment of
overpayments
Automated Adjustment Process allows for systematic recoupment of
overpayments. The automatic recoupment of an overpayment
occurs when a provider has been over paid for a service.
 What creates an overpayment?
 An adjustment transaction that pays less than the original bill
payment
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A denial for a service that was previously paid
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Example: Provider changes re-billed units and/or billed amount to be
less the units or the total amount originally submitted
Example: Provider changes the billed CPT that previously paid. The
new CPT requires authorization and denies.
The overpayment will create a credit balance on file and a debt to
DOL
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How do I know if I have a debt
owed to DOL?
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Notification of over payments will post to your
RV for the amount payable to DOL for each
bill affected
Review your RV for a total amount payable to
DOL for each District Office
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Look for the field labeled “Ending Credit Balance
Payable to Dept. of Labor”
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Overpayment RV –
Outstanding balance on RV
“Ending Credit Balance Payable to Dept. of Labor”
Overpayment created from this TCN
Total amount now owed to DOL
Total
amount paid
due to other
bills paid
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Overpayment info – Outstanding
balance on Web Portal
40903112345678901
1234567
Amount Owed:
Overpayment
created
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How is the money recouped?
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If a provider has a credit balance with OWCP,
the amount will be automatically recouped
from future bills submitted for the same
provider AND same claimant
If you send a refund to DOL, please ensure to
repay the full overpayment amount from the
originally submitted bill
Partial repayments will not prompt an
adjustment
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Recoupment info on RV – debt
satisfied
Payable amount
Payable
amount of
$106.30 is
applied to
two previous
overpayment
TCNS on file
for the
claimant
Beginning total amount owed to DOL
Amount recouped from this pay cycle
Remaining total amount owed
Amount remitted
after recoupment
and debt
satisfaction for
that claimant23
Recoupment info on Web
Portal
40932112345678901
Payable
amount of
$106.30 is
applied to
two previous
overpayment
TCNS on file
for the
claimant
4093211234567908
60932130300300033
Payable amount
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How can I owe a debt to DOL
yet still receive payment?
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The FECA Program assigns a credit balance
based on the claimant for which services
were performed.
Future recoupments will occur on bills
submitted for services rendered to that
particular claimant.
If you treat other DOL FECA claimants
without a debt on file for their bills, you will
receive payment for those services.
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Recoupment info on RV – monies
credited and debt remaining
Overpayment on file for claimant
Amount recouped and
credited to overpayment
Remaining amount owed
to DOL for this claimant
Payable
amount is
applied to
previous
overpayment
TCN (s) on
file for the
claimant
Remaining total amount owed to DOL
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If I bill for multiple claimants, how do I tell
which case has the overpayment on file?
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Credit balance summary page on your RV will show
each claimant ID along with TCN, date the balance
was created, and balance amount
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Payment
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An adjustment transaction may pay additional monies to you if:
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Previously submitted charges for a procedure denied due to claimant
eligibility edits
Claimant case is now open and payable.
Bill has been resubmitted for payment.
The RV will show the credit (negative) and debit (positive)
 The RV will state “Net amount payable to you”
“Net amount payable to you” - Only appears for positive adjustments –
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Payment – Bill inquiry on Web
portal
00932110200100100
987654
00912330305555530
00932110200200100
00932110200200100
987654
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Refund
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An adjustment transaction that shows too much money
was recouped from the provider.
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The RV will state “Net amount refunded to you”
CLAIMANT NAME
121234567
0-09321-20-200-5555-55
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What if I have not received
payment?
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If it has been less than 45 days from date of
payment, please allow the designated
timeframe to occur before requesting
assistance
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If it has been more than 45 days from the
date of payment, please call the ACS Call
Center at (844) 493-1966 and request a
check trace.
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Return to Providers (RTP)
process
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Request RTP reasons
If request for an adjustment is incomplete the request will be returned for
additional information. Reasons for RTPs can include:
 A TCN must be correct and on file for adjustment processing
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If it is not, the request will be RTP’d for “TCN not found, not valid, or
not legible.”
A requested adjustment or resubmitted bill that has been requested
in the last 10 business days, (please allow 10 business days from
date of receipt to pass before additional submissions)
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The request may be RTP’d for “TCN is currently being adjusted and
in process”
If a request is submitted more than three (3) times, the adjustment
request will be reviewed manually
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Return to Provider RTP reasons
(continued)
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The claimant’s nine (9) digit case number and
claimant name are required fields.
Your nine (9) digit ACS Provider number, name, and
address are required fields.
 If you do not know the case number or your
provider number, please call the ACS call center
at (844) 493-1966 Monday -Friday 8 a.m. to
8 p.m. EST for assistance
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Return to Provider RTP
Reasons (continued)
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An explanation of adjustment reason is
required
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You may submit the verbiage “see attached.”
A corrected bill is required for processing
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An RV indicating TCN to be adjusted may also be
accepted
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Appendix A: Definitions
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RV = Remittance Voucher or the explanation of
benefits
Adjustment = a request for reprocessing of a
previously processed bill
Appeal = a request for reconsideration of a payment
calculated through the fee schedule
Credit balance = amount owed to DOL due to an
overpayment for services previously billed (also
called: a debt, or an outstanding balance)
Credit = a reversal or void of a previous processed
bill
Debit = a bill that remits monies to the submitter
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Appendix B: FAQ Page
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Click the link below for a 1 page overview
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FAQ Document for Providers
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Appendix C: Helpful Links
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ACS-DOL Web Portal Home Page
http://owcp.dol.acs-inc.com
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ACS-DOL adjustments request template
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http://owcp.dol.acs-inc.com/portal/formsAndLinks.do
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ACS-DOL Web Portal registration page
https://owcp.dol.acsinc.com/sso/registration/providerAccount.do
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