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. An MCO is a private company that
contracts with the BWC to perform medical management and return to work services.
MCO's work with providers to approve reimbursement for treatment and process
bills for payment.
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.
Its responsibilities include handling first reports of injury, providing authorizations
for medical procedures, processing providers' bills for payment by the BWC,
and driving the return-to-work process. Its staff is clinically focused and
includes medical professionals.
A third-party administrator (TPA) helps administer the legal and financial portions of a claim. Its responsibilities include providing legal and risk management advice to employers, litigating claims that the employer feels are unwarranted, working with employers to develop Workers' Compensation cost control strategies. Its staff typically consists of claims adjusters, underwriters and statisticians.
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 Premier Comp 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 determining if a claim is compensuble, assigning
a claim number, identifying the allowed conditions in a claim, paying indemity
compensation or lost wages and 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 time limit from the date of injury
or diagnosis on filing a new claim.
For the Provider
Can I treat or bill for condition not recognized or
allowed in a claim?
The MCO is responsible for payment of medical services provided in the treatment
of allowed conditions.
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).