For the Employer & Injured Worker
Where can I see your Report Card?
Access the most recent BWC Report Card here.
What is a MCO?
MCO stands for Managed Care Organization. MCO's facilitate the reporting
of claims, provide medical case management services, review treatment requests
for appropriateness, facilitate services and review and approve provider
payments.
What is the difference between an MCO and a TPA?
Under Ohio's Health Partnership Program, the managed care organization (MCO)
is responsible for the medical management of work-related injuries and illnesses.
MCO responsibilities include handling first reports of injury, providing
authorizations for medical procedures, processing providers' bills for payment
by the BWC, and facilitating the return-to-work process. MCO staff are medical
professionals and their processes are clinically focused.
A Third Party Administrator (TPA) assists employers in the administrative and financial aspects of a claim. Their responsibilities include providing risk management advice to employers, Industrial Commission hearing representation and assisting employers in developing workers' compensation cost control strategies. TPA staff typically consists of claims adjusters, account represntatives and workers' compensation professionals.
What paperwork needs to be completed?
In cases requiring medical treatment, you should complete an incident report
(if your employer requires this) and the first two sections of the FROI-1
(First Report of Injury form). Be as specific as possible when completing
these forms. Failure to complete the internal incident report and FROI-1
could delay processing of your Workers' Compensation claim.
Where can I get treated? Do I have to treat with
a specified physician?
You have the right to seek medical treatment from any BWC certified physician
or medical facility. If you need assistance locating a BWC certified provider,
contact The Health Plan Managed Workers' Compensation Program or access
the Ohio BWC website at www.ohiobwc.com.
Before seeking treatment from any provider, you should
determine if they are BWC certified. If treated by a non-certified provider,
you may be responsible for payment.
What is the role of the Bureau of Workers' Compensation
(BWC) in a claim?
The BWC is responsible for allowing or disallowing a claim (compensability),
assigning a claim number, identifying the allowed conditions in a claim,
paying lost time compensation or lost wages and the adjudication of legal
issues.
Who pays my benefits and medical bills?
The BWC makes the final decision regarding payment of compensation and will
pay all compensation benefits in accordance with BWC rules and regulations.
Medical bills are submitted to the Managed Care Organization (MCO) and electronically
processed and forwarded to the BWC. The BWC then electronically transfers
funds to the MCO and the MCO authorizes payment and sends the check to the
provider.
How long does an injured worker have to file a
claim?
BWC statutory rules provide a two-year filing time limit from the date of
injury or diagnosis of an occupational disease.
For the Provider
Can I treat or bill for condition not recognized
or allowed in a claim?
The MCO may only reimburse for treatment of an allowed condition in an allowed
claim. If you feel that a new condition needs to be added to a claim, you
can submit a C-9 form with supporting documentation. The Ohio BWC makes
all claim and condition determinations.
Can I bill an injured worker if he/she misses an
appointment?
Per the BWC, reimbursement will not be made for failed appointments.
How does an injured worker choose a provider?
Injured workers can choose any provider they wish for an initial visit,
if it is an emergency. After the initial visit, an injured worker may see
any provider that is certified by the Ohio Bureau of Workers' Compensation
(BWC).