Forms Catalog Document - OWCP1500 :-: ESA :-: Health Insurance Claim Form

Forms.gov - The U.S. Government's Official Hub for Federal Forms

Skip Navigation

Home

Forms FAQs

Give Feedback

Locate a Form

By Agency

By Agency/Subagency

By Form Number

By Form Name(A-Z)

Frequently Used Forms

Tax Forms

Small Business Forms

Social Security Forms

Veteran Benefit Forms

FEMA Forms

Health Insurance Claim Form

Health Insurance Claim Form OWCP is requesting approval of a non substantial change to the Form OWCP-1500. OWCP is adding the data elements National Provider Identifier(NPI) and taxonomy number which will be 32a and 33a on the revised OWCP-1500. This information is required to pay health care providers for services rendered to injured employees covered under the Office of Worker's Compensation Programs - administered programs. Appropriate payment cannot be made without documentation of the medical services that were provided by the health care provider that is billing OWCP.

Form #: OWCP 1500
Agency: Department of Labor
Bureau: Employment Standards Administration
Common Name: OWCP-1500

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Both Form and Instructions	4		[3] Fillable + Printable	Adobe Reader Download

Still Cannot Find a Specific Form Here?

If you do not find the form you need in the E-Forms Catalog we suggest:

Search through the Agency Forms links.

Search USA.gov, a connection to the U.S. Government's information and services.

Search GSA (GS), Standard (SF) and Optional (OF) Forms, the General Services Administration's library for GSA internal forms and government-wide Standard and Optional Forms.