How to Report an Injury

Contact The Health Plan Managed Workers' Compensation Program (MWCP) at 1.888.847.7810 (ext. 6109).
Seek treatment from BWC-certified provider.
Take a The Health Plan Managed Workers' Compensation Program (MWCP) identification card to your medical provider.
If you cannot reach The Health Plan Managed Workers' Compensation Program (MWCP), you may complete a First Report of an Injury form (FROI-1).

The Health Plan Managed Workers' Compensation Program (MWCP) Identification Card

The Health Plan Managed Workers' Compensation Program (MWCP) identification cards should be distributed to all employees and used for work related injuries only. When an injured worker seeks treatment for a work related injury, he or she should present their identification card to assist in identifying the employer and MCO. This will assist in expediting medical treatment and the claims process.

If you would like to order additional identification cards or have any questions or concerns, you may contact The Health Plan Managed Workers' Compensation Program (MWCP) via email or by calling 1.888.847.7810 ext. 6109. (Front and back of card shown below.)

Services

Case Management
Case Management is a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates options and services to meet a client's health needs through communication and available resources to promote quality, cost-effective outcomes.

The Health Plan Managed Workers' Compensation Program (MWCP) is certified in Case Management by the American Accreditation HealthCare Commission (URAC). We have certified Case Managers (CCM) who work with injured workers, employers, and healthcare providers to perform the functions of Case Management. The ultimate goal in working with injured workers is to assist them in reaching an optimal level of functioning and wellness while achieving a safe and timely return to work. In working toward this goal, it is the Nurse Case Manager's responsibility to ensure that services are appropriate to the injury and generated in a timely and cost-effective manner.

Vocational Rehabilitation
Vocational Rehabilitation is the process of restoring an individual’s ability to work. Our goal at The Health Plan Managed Workers' Compensation Program (MWCP) is to integrate Vocational Rehabilitation services with your return-to-work policies to save money and reduce lost-time days.

Vocational Rehabilitation is an individualized program for eligible injured workers needing assistance in safely returning to work or in retaining employment. Vocational Rehab emphasizes restoring or maximizing the injured worker's abilities and minimizing long debilitating absences from work.

Vocational Rehabilitation benefits employers by providing:

Earlier return-to-work and reduction in lost time.
Individualized return-to-work plans for your injured workers.
Analysis of the job site and help in identifying modified work.
Employer incentives and gradual return-to-work plans.
Job retention services for injured workers continuing to have difficulty with job demands.

Quality Assurance
The Health Plan Managed Workers' Compensation Program (MWCP)'s quality improvement program monitors and evaluates the effectiveness of Case Management and claims Management. The Quality Assurance Committee maintains and updates policies and procedures to ensure compliance with URAC standards and assess the quality of treatment reimbursement decisions and billing procedures in connection with approved treatment reimbursement. The Health Plan Managed Workers' Compensation Program (MWCP)'s Quality Assurance Program is responsible to ensure quality Case Management of Ohio's injured workers by tracking key quality indicators.

Consumer Bill of Rights

The purpose of the "Bill of Rights", is to safeguard the individual's rights while assisting and identifying medical and vocational goals and barriers. The consumer and their support system(s) have the right to:

Expect strict confidentiality, security and personal privacy of consumer specific information, including medical records
Know the process by which consumers are informed of choices regarding services
Appeal treatment reimbursement decisions
Education regarding the nature of the Case manager's role and responsibility to the consumer, employer and Ohio Bureau of Workers' Compensation
The circumstances in which information obtained in the Case Management relationship will be disclosed to third parties
Be notified in writing of Case Management actions and recommendations
A complaint process
A description of the rationale for selecting consumers for Case Management services
Refuse Case Management services without loss of Workers' Compensation benefits
Obtain information regarding The Health Plan Managed Workers' Compensation Program (MWCP)'s criteria for Case closure
Have input into the Case Management plan
Receive notification and a rationale when Case Management services are changed or terminated
The use of end of life and advance care directives honored
The use of alternative approaches when the consumer and/or family is unable to fully participate in the assessment phase

Grievance and Dispute Process

Grievance Process
The Health Plan Managed Workers' Compensation Program (MWCP) has a process to resolve administrative issues or complaints affecting the Management of the claim or an employee. All complaints regarding a Case Management issue or Administrative process should be directed to The Health Plan Managed Workers' Compensation Program (MWCP). Managers will attempt to bring resolution within 48 hours for all complaints or grievances. If grievances are not resolved to the satisfaction of the customer, they may formally appeal the decision, in writing, to The Health Plan Managed Workers' Compensation Program (MWCP) within 14 days of the decision.

The Health Plan Managed Workers' Compensation Program (MWCP) is required by the BWC to have an Alternative Dispute Resolution (ADR) process. ADR affords due process regarding conflicts in medical treatment issues. Disputed issues may include:

Quality Assurance
Utilization Review
Determination that a service is or is not covered
Treatment/service necessity
Issues involving health care providers

Injured workers and their representatives, employers and their representatives, or providers may initiate ADR by contacting The Health Plan Managed Workers' Compensation Program (MWCP) in writing. The disputing party should identify the issue with The Health Plan Managed Workers' Compensation Program (MWCP)'s decision, within 14 calendar days of receipt of written notice of an initial treatment reimbursement determination.