Managed Care

MCO Basics

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Published on May 24

The Ohio Bureau of Workers’ Compensation (BWC) understands that handling workers’ comp claims and tending to the needs of injured workers can be difficult for many businesses to accomplish on their own. For this reason, all Ohio employers are required to select a state-approved managed care organization (MCO) to help fulfill their claim and employee responsibilities.

MCOs are an invaluable resource in the world of workers’ compensation. They provide the support and coordination employers need to ensure their injured workers receive the care necessary for a successful recovery and a timely return to work. When it comes to selecting an MCO partner, there are some basics that are very helpful to know.

Make Your Selection

As mentioned above, for state-fund employers in the Ohio workers’ comp system, choosing an MCO is not optional.

In fact, for brand new companies, the clock starts ticking as soon as the certificate of coverage is received. A voluntary MCO selection must be made within 30 days of receipt or the BWC make a random MCO assignment on the employer’s behalf. Existing companies that already have a workers’ comp policy in place may elect to switch MCOs only during the biennial open enrollment period. Since MCO partnerships last for a minimum of two years, it’s important for owners and managers to weigh their options carefully, evaluate the merits of each organization, and choose the MCO that best fits their needs.

While there are ten MCOs for Ohio employers to choose from, Sheakley UniComp has the industry experience and depth of knowledge needed to help companies control workers’ comp claims costs and ensure their injured workers are receiving the best medical case management possible.

Once businesses reach a decision on which MCO is right for them, they must complete and submit the MCO Open Enrollment form in a timely manner. Since working with an MCO is one of the requirements for obtaining workers’ compensation insurance, MCO fees are paid by the BWC out of employers’ annual premiums.

MCO Core Responsibilities

MCOs perform many critical functions in the workers’ compensation process, including the medical management of claims and administering return-to-work programs. Sheakley UniComp’s staff handles all the details of its clients’ workers’ comp claims, allowing them to focus on managing other aspects of their businesses.

Foremost amongst its responsibilities, Sheakley UniComp:

  • Collects initial workplace injury reports and transmits them to the BWC
    While employees have up to one year to file a workers’ compensation claim, workers are encouraged 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. Employers should work with their injured workers to complete the FROI and decide who will submit the form to the BWC — either the employer, injured worker, Sheakley UniComp, or the physician.

    In order to prevent delays or other issues, the Sheakley team reviews all FROIs to ensure that all necessary information is included in each submission.

  • Manages and authorizes medical treatment by BWC-certified providers
    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, we also authorize and deny medical treatment requests and coordinates with all medical care providers to facilitate the safe and timely return to work of injured workers. Our team 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 medical costs for employers and ensure that all charges 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 consistent with 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 facility or provider. Following the initial treatment phase, injured workers must receive care 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 programs
    Since the goal of case management is for injured employees 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 and take longer to heal than others, or that some employers don’t have viable alternative job duties for injured employees to perform, we can work with clients to identify a temporary modified duty local nonprofit assignment or transitional work assignment for their injured worker during their recovery. These types of positions allow employees to stay engaged and connected to the workforce until they’re able to return to their regular full-time position.

  • Conducts drug utilization review
    Because opioid and other prescription drug-related issues continue to impact Ohio’s workplaces, Sheakley UniComp conducts regular drug utilization reviews on all claims involving these types of medications. Our 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.

  • Processes treatment appeals through the Alternative Dispute Resolution (ADR) process
    When Sheakley UniComp decides on medical treatment requests, the injured worker, employer, or a representative can appeal through Alternative Dispute Resolution (ADR) process.

Select Sheakley UniComp

As one of Ohio’s biggest and most tenured MCOs, we strive to serve the best interests of both companies and injured employees. We guide our clients through the often-confusing world of workers’ compensation and help them control the costs of claims, manage medical treatment, and get their employees return to work quickly and safely.

There is still time to select Sheakley UniComp as your MCO. Complete our enrollment form or learn more today!

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