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OWCP requires that charges be itemized using the AMA standard “Health Insurance Claim Form” (AMA OP 407/408/409; OWCP-1500, or HCFA-1500). Each procedure must be identified. In Column 24 C of the form, by the applicable Current Procedural Terminology (4th edition) Code CPT 4).
CA-16: Authorization for Examination and/or Treatment. This form is only available to authorized employing agency personnel, and may be obtained in electronic format via the Agency Query System (AQS) or ECOMP, or by contacting the employing agency workers’ compensation personnel. CA-17* Duty Status Report: CA-17 (En Español)* Informe de ...
Medical Treatment - Form CA-16. If an employee requires medical treatment for a traumatic injury, supervisor should complete front of Form CA-16, within four hours of request whenever possible. If supervisor doubts whether employee’s condition is related to employment, he/she should so indicate on Form. CA-16.
11 lip 2023 · OWCP requires that when services are performed in an emergency situation, and in an Acute Care Facility for emergency surgery or care, a copy of the OWCP Uniformed Billing Form (UB-04-1450), should be supplied together with the submitted Form CA-16.
This form is used by the employing agency to refer an employee who sustains a work-related traumatic injury to a local physician or hospital of the employee’s choice. The CA-16 form allows for authorization of medical treatment for 60 days from the date of injury, unless OWCP terminates the authorization sooner.
Form CA-16 guarantees payment to the original treating physician (or any physician to whom the original treating physician refers the employee) for 60 days from date of issuance, unless OWCP terminates this authority at an earlier date.
OWCP Form CA-16 Instructions. Authorization for Examination and/or Treatment. Summary. Purpose Authorization for an employee to obtain medical care or treatment from a doctor or medical facility of his or her choice following an injury or illness.
