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Published on May 24
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The Bureau of Workers’ Compensation (BWC) understands that businesses of all sizes need assistance with handling workers’ compensation claims. So, they require all employers select one of the state-approved managed care organizations (MCOs) to work with on their claims. This helps achieve the injured workers receiving the appropriate care needed for recovery, timely return to work, and providing coordination between all parties involved. MCOs are an invaluable resource in the world of workers’ compensation. When it comes to selecting an MCO partner, here are the basics you need to know.
Start the clock
For state-fund employers in the Ohio workers’ comp system, working with an MCO is not optional. In fact, when it comes to selecting the MCO you plan to work with, the clock starts as soon as your company receives its certificate of coverage.
All new employers must select an MCO within 30 days of receipt of the certificate of coverage. If an employer does not select an MCO, the BWC will assign an MCO to the company. If you run an established company that already has a workers’ comp policy in place, you may elect to switch MCOs only during the biennial open enrollment period. Since you’ll be working with your MCO partner for the next two years, it’s important to choose the company that best meets the needs of your company.
While there are numerous options available to employers, Sheakley UniComp can help your company control workers’ comp costs while also ensuring that your injured worker’s case is receiving the best claims management possible.
Once you’ve reached a decision, be sure to complete the MCO Open Enrollment form in a timely manner, as delays mean that your company could be automatically assigned to an MCO that isn’t the right fit for your business. Since working with an MCO is a requirement of obtaining workers’ compensation insurance, the fees for the MCO are paid by the BWC out of the employer’s premiums for each year.
MCO’s Core responsibilities
MCOs perform many critical functions in the workers’ compensation process, such as medically managing workers’ compensation claims and administering return to work programs. Sheakley UniComp’s staff will handle all the details of your workers’ comp claims, allowing you to focus on running your business.
Among other responsibilities, Sheakley UniComp:
- Collects initial workplace injury reports and transmits to BWC
While employees have up to one year to file a workers’ compensation claim, you should encourage workers to report workplace accidents immediately. Early reporting and diagnosis of an injury can help reduce the length of treatment and limit lost time payments. No claim can be filed until a First Report of Injury (FROI) is completed, detailing the date and nature of the accident, those involved, and other pertinent details. Work with your injured worker to complete the FROI and decide who will submit the form to the BWC – either the employer, injured worker, Sheakley UniComp, or the physician.
Sheakley UniComp reviews all FROIs, submitted by the worker or their physician, to ensure that all necessary information was included to prevent delays or other issues.
- Manages and authorizes medical treatment to be provided by a BWC-certified provider
Sheakley UniComp provides medical management for all claims, including obtaining initial claim data and medical records on behalf of the BWC. In addition to ensuring that workers are receiving treatment in a timely and efficient manner, Sheakley UniComp also authorizes and denies medical treatment requests and coordinates with all medical care providers to facilitate the safe and timely return to work of injured workers. Sheakley UniComp communicates with all providers involved in the treatment of the injured worker to ensure that treatment is consistent and customary.
- Conducts medical review and bill payment processing
To help control costs for employers and ensure that all medical costs are reasonable, Sheakley UniComp provides medical review and bill payment processing for all claims. Sheakley UniComp’s claims management experts ensure that all bills submitted are customary for the type of injury sustained.
- Maintains a network of BWC-certified healthcare providers
In the immediate aftermath of a workplace accident, injured workers may seek medical treatment from any medical treatment facility or provider. However, after their initial treatment, injured workers must receive treatment from a BWC-certified medical provider.
Sheakley UniComp’s network of BWC-certified providers offers unsurpassed care to injured workers while also providing employers access to incredible cost savings. Offering discounts of up to 20% below the BWC fee schedule, our provider network includes physicians with experience in every industry to provide your workers with top-notch care.
- Administers return to work services
Since the ultimate goal of case management is for your injured employee to return to work as quickly and safely as possible, Sheakley UniComp approaches every claim with that outcome in mind.
Understanding that some injuries are more severe or take longer to heal than others or that some employers don’t have viable alternative job duties for injured employees to perform, Sheakley UniComp can even work with you to identify a temporary modified duty off-site assignment or transitional work assignment for your injured worker at a local nonprofit during their recovery. These positions allow your employees to stay engaged and connected to the workforce during their recovery while building additional tools that they can use if they are able to return to full capacity with you at a later date.
- Conducts drug utilization review
As opioid and other prescription drug-related issues continue to affect the workplace, Sheakley UniComp conducts regular drug utilization reviews on all claims involving these prescriptions. Sheakley UniComp’s case managers work with medical providers to ensure that injured workers receive the appropriate medications for their injury, while also working to limit the potential for abuse or addiction to develop.
- Processes treatment appeals through the Alternative Dispute Resolution (ADR) process
When Sheakley UniComp decides on medical treatment requests, the injured worker, employer or rep can appeal through Alternative Dispute Resolution (ADR) process.
Sheakley UniComp serves both the best interest of your company, and your injured employees. We can guide you and your workers through the often-confusing world of workers’ compensation. We can help you control the costs of claims, manage medical treatment, and help your employees return to work quickly and safely.