Ohio Workers’ Compensation: Who to Contact and When

Workers’ compensation can be a very difficult system to navigate. It is important for you to know the difference between the Ohio Bureau of Workers’ Compensation (BWC), your Managed Care Organization (MCO), and your Third Party Administrator (TPA). Below is a summary of which party handles what responsibilities:

BWC Handles MCO Handles TPA Handles
Claim evaluation Medical case management Claim management
Compensation determination Triage by RN for case management needs and case assignment Hearing representation
Assignment of claim number 3 pt. contact with injured employee, employer and medical provider Claims award and reserve auditing
Wage calculation for compensation payments Utilization review Manual classification auditing
Assignment of customer service team Peer review, quality assurance and alternative dispute resolution. Payroll report auditing
Compensation/award payment Bill processing Experience rating and premium rate verification
Provider certification Outcome measurements & statistical analysis Alternative rate analysis
Identification & auditing employers Education Pursue lump sum settlement
Education Filing motions, appeals and protests
90 day exams Handicap reimbursement
Fraud investigation Schedule independent medical exams
Approval of lump sum settlements Education

When to contact BWC When to contact MCO When to contact TPA
Initial determinations Initial report of injury Claim status
Allowance of additional conditions Questions on medical bills Questions on certification and compensation
Compensation benefit determination Questions on treatment Independent medical exams
Fraud Change of physicians Receipt of hearing notice
To request an exam or check status of an exam Medical records/documentation Lump sum settlement
Wage information Treatment plans Fraud
Living maintenance MCO network of physicians Safety programs
Monetary awards Return-to-work questions Violation of specific safety requirements
Rehabilitation Excessive treatment
Fraud BWC/IC orders
Utilization management Rate questions & payrolls audits
MCO procedures Questions concerning WC coverage
To request an exam or check status of an exam

It is important for the medical management of any workplace injury to communicate and collaborate. If you are ever unsure of who to contact, place your trust in your MCO, and they will lead you in the right direction.

By | 2017-06-09T16:36:09+00:00 June 9th, 2017|Industry Insights|0 Comments
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