The file's text, extracted by GovTribe without its formatting.
United States Department of Labor
(DOL)
Workers’ Compensation Medical Bill Process (WCMBP)
Attachment 23 –
Government Furnished Information Template
December 30, 2013
Office of Workers’ Compensation Programs (OWCP)
Government Furnished Information The following table identifies the global GFI information/items that will be supplied to the Contractor by the Government:
| Description |
| Data Source(s) |
| Treatment Suite Files |
| Government |
| Treatment Suite Documentation |
| Government |
| Treatment Suite Builder Software, Source Code |
| Government |
| Treatment Suite Viewer Software, Source Code |
| Government |
| Treatment Suite Data Base |
| Government |
| Treatment Suites Updates |
| Government |
| Excluded Providers List |
| Government |
| Claimant Eligibility Files layouts |
| Government |
| GSA Reimbursable Mileage |
| Government |
| OWCP Fee Schedules |
| Government |
| List of Maryland Hospitals exempted from PPS |
| Government |
| List of Medical facilities of the US Public Health Service, Departments of the Army, Navy, Air Fore, Veterans Affairs (exempted from PPS) |
| Government |
| ZIP Code Files |
| Government |
| Relative value Units (RVUs) and Geographical Modifiers |
| Government |
| CCR Tables |
| Maintained and distributed by the U.S. Department of Health and Human Services. (quarterly) |
| CMS Correct Coding Initiative |
| Maintained and distributed by the U.S. Department of Health and Human Services. |
| Homegrown Codes |
| Government |
| Surgical ICD-9CM Codes |
| AMA |
| Copies of all Medical Claims/Billing Forms |
| Government |
| Copies of all Medical Travel Refund Request Forms |
| Government |
| Copies of Survivor’s Forms |
| Government |
| Fee Schedule Data |
| Government |
| Service Level Definitions |
| Government |
| Interface File Layouts/Formats |
| Government |
| Lists, Contents, and Descriptions of all EOB messages |
| Government |
| Payments, Claims & Enhanced Reconciliation System (PACER) Application |
| Government |
Electronic copy of the “Welcome Package.”
Government
| Key Deliverable Templates |
| Government |
