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Dear Provider: Thank you for your interest in participating as a medical services provider for the four programs administered by the U.S. Department of Labor\'s Office of Workers\' Compensation Programs
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How to fill out owcp-1168 provider enrollment

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How to fill out owcp-1168 provider enrollment form

01
Obtain the OWCP-1168 Provider Enrollment Form from the Department of Labor website or local OWCP office.
02
Fill in your personal information including name, address, contact information, and Tax Identification Number (TIN).
03
Provide details about your practice or facility including the services you offer and any specialties.
04
Attach any required documentation such as copies of your professional licenses, malpractice insurance, and accreditation certificates.
05
Review the form for accuracy and completeness before submitting it to the OWCP for processing.

Who needs owcp-1168 provider enrollment form?

01
Healthcare providers who wish to provide medical services to injured federal employees covered under the Federal Employees' Compensation Act (FECA).

What is OWCP-1168 Provider Enrollment - OMB 1240-0021 Form?

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Instructions for the OWCP-1168 Provider Enrollment - OMB 1240-0021 form

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The OWCP-1168 provider enrollment form is a form used by medical providers to enroll in the OWCP's medical provider network for the treatment of injured federal employees.
Medical providers who wish to provide treatment to injured federal employees under the OWCP must file the OWCP-1168 provider enrollment form.
The OWCP-1168 provider enrollment form must be completed with the provider's information, including contact details, specialties, and information about the provider's practice.
The purpose of the OWCP-1168 provider enrollment form is to gather information about medical providers who wish to participate in the OWCP's medical provider network.
The OWCP-1168 provider enrollment form requires information such as provider's name, contact information, practice specialties, and details about the provider's practice.
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