Federal Employees' Compensation Act

Claim Forms & Instructions

Administrative Forms & Links

Claimant Medical Reimbursement (OWCP-915)

Medical Travel Refund Request (OWCP-957)

Health Insurance Claim Form (OWCP-1500) | (Instructions)

Uniform Health Insurance Claim Form (OWCP-04) | (Instructions)

ADA Dental Claim Form

How to Submit a Paper Pharmacy Bill

FECA Pharmacy Payer Sheet: Batch Claims

FECA Pharmacy Payer Sheet: Third Party Billers

FECA Pharmacy Payer Sheet: All Other Providers

Provider Enrollment Application:Downloadable Form

Provider Enrollment Training Presentation:

How to Complete a Provider Enrollment Application Tutorial (Individual)
How to Complete a Provider Enrollment Application Tutorial (Facility)
How to Complete a Provider Enrollment Application Tutorial (Group)
How to Complete an ACH Vendor Payment Form Tutorial

Medical Authorization - Durable Medical Equipment^*

Medical Authorization - General Medical/Surgical^*

Medical Authorization - Physical Therapy^*

Medical Authorization - Transportation and Travel^*

Medical Authorization - HCPCS J-Code Unspecified/Unclassified^*

DFEC Third Party Carrier NALC Form
(For use by Provider's of type 95 only)^*

To order Pharmacy Universal Claim Forms, please call Moore-Wallace North America at (800) 635-9500. For more information you may view theNCPDP site.

P2P EDI Information

Conduent EDI Gateway Information

To enroll with EDI, please complete this document: EDI Enrollment Form

EFT Form | (Instructions)

Provider Change of Address

FECA Contact Info

FECA FAQ

Adjustment Request