1 How To Enroll/Register and Update Provider Information with ACS

2 Why Enroll? Enrollment/Registration is required to receive payment from OWCP for treatment of injured workers Enrollment/Registration is required to receive payment from OWCP for treatment of injured workers Registration process, not a PPI enrollment Registration process, not a PPI enrollment Provides you with your unique provider ID/number necessary for bill processing Provides you with your unique provider ID/number necessary for bill processing

3 Why Update Information? To provide current mailing information To provide current mailing information To provide current financial institution information if payments are received via Electronic Fund Transfer (EFT) To provide current financial institution information if payments are received via Electronic Fund Transfer (EFT)

4 How to Enroll The Best/Fastest Way: Enroll is via the website at The Best/Fastest Way: Enroll is via the website at Call Call  Select enrollment option  Request provider packet

5 Help in Completing the Provider Enrollment Form Provider Enrollment Form Box: 1.If the provider is updating their current provider file the update box must be checked. 2. This information is not required The practice name & address (only a physical address is acceptable as the practice address) 8. The practice telephone number is required. 9. The practice fax is not required. 10. The practice type is required.

6 Help in Completing the Provider Enrollment Form Provider Enrollment Form Box: 11a. The numerical provider type is required. 11b.The provider type description is required. 11c. Explanation of services for provider type 96 & Tax id or SSN is required 13. Medicare number is required for all Acute medical hospitals. 14a,b,c,d,e. The individual provider license/certification information is required for all M.D&DO. 15. Not required.

7 Help in Completing the Provider Enrollment Form Provider Enrollment Form Box: 16a,b,c,d. Billing/Remit address is required if applicable. 17. Is required for DCMWC (Black Lung) & DEEIOC (Energy). Optional for FECA 18. Is not required this is a request by the provider to submit bills electronically Signature & Date is Required.

8 Since The Fastest Way to Receive Payment is via EFT Select EFT on the provider application form Select EFT on the provider application form Submit a completed EFT form Submit a completed EFT form

9 How to Update Provider Information Submit address changes online at Submit address changes online at Mail completed address change request or form to: Mail completed address change request or form to: PO Box Tallahassee, Fl Tax ID number (TIN) changes must be submitted via mail. Tax ID number (TIN) changes must be submitted via mail.  Identify old TIN to be terminated and new TIN  Submit a copy of your license