Managed Care

MCO Selection Guide

Sheakley
Reading time 4 Mins
Published on May 3
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Your Managed Care Organization (MCO) partner plays a critical role in how efficiently your workers’ compensation claims are handled. Since the Bureau of Workers’ Compensation (BWC) requires you to work with an MCO, and you can only change that MCO during open enrollment every two years, it is crucial to select an MCO that best fits the needs of your company. Here are our tips to help you select an MCO partner you can trust.

Trusted professionals

First and foremost, your MCO partner must offer medical management of all of your workers’ comp claims with processes that are clinically focused. From the First Report of Injury (FROI) to the injured worker’s recovery, your MCO acts as the main point of connection between all parties involved.

Sheakley UniComp provides medical management for all of your company’s workers’ comp claims. This includes obtaining initial claim data and medical records for the BWC, and managing/paying all medical provider bills. Reviewing bills from providers helps keep costs down by ensuring all medical bills are appropriate for the claim. Sheakley UniComp also authorizes and denies all medical treatment requests on your behalf, while working with the medical provider to help facilitate the injured worker’s safe return to work.

Drug utilization review

It’s an unfortunate reality that even prescription medications are often mis-prescribed by doctors or abused by patients during recovery. As a result, drug utilization reviews are a standard component of the claims management protocol. This allows your MCO to identify inappropriate prescriptions and/or excessive use, possibly leading to drug addiction.

This proactive approach allows Sheakley UniComp to ensure the health and safety of your injured workers. With the prevalence of abuse of prescription pain killers by both medical providers and patients, taking measures to identify and halt potential abuse before it gets out of hand can significantly improve outcomes for your workers.

Proactive return to work strategies

Lost-time claims are the most expensive type of claims. They quickly add up and contribute to future premium increases. Your MCO partner should have solid return to work strategies in place to help return injured workers to the job as soon as they are medically cleared.

To help employers in industries such as construction or manufacturing, that have traditionally not been able to accommodate modified duty in the workplace, Sheakley UniComp’s strategy includes non-profit return to work programs to help shorten the length of lost-time claims. Once an injured worker has been medically cleared to return to work with modifications, our non-profit return to work programs place the worker with one of the nonprofit organizations in our nationwide network. We work with the employer to ensure that the non-profit aligns with the company’s values and mission. By staying engaged and connected to the workforce during the recovery, your worker’s claim is less likely to develop into a total disability.

Make an informed decision

To make it easier for employers to evaluate the performance of every MCO in the state and make an informed decision about MCO open enrollment, the BWC created the MCO Report Card. The report card is updated each year based on assessments gathered during the prior premium year. Rather than randomly selecting an MCO or being assigned one by the BWC, the Report Card puts the scores of every MCO in your hands.

Treating the whole person

Sheakley UniComp understands that every claim is different and that every injured worker requires a unique level of assistance, that’s why we believe in looking beyond just the medical needs to treat the whole person.

After beginning treatment for depression, an injured worker was diagnosed with early-onset dementia and Alzheimer’s in September of 2019. Due to the effects of the disease and without family in the area to provide assistance, the injured worker was having issues with remembering appointments. Sheakley UniComp’s case manager assigned to the injured worker helped the worker set reminders for medications and appointments, to use post-it notes to keep track of notes and important information, and ensured that medication for blister packaged for morning and evening. Additionally, the case manager helped the injured worker get in touch with the council on aging in their area for ongoing assistance.

You need an MCO that understands your injured workers unique needs and will do what they can to help.

An MCO partner you can trust

Sheakley UniComp can guide you and your workers through the confusing world of workers’ compensation, helping you control the costs of claims, managing medical treatment, and helping your employees return to work quickly and safely.

Now is MCO Open Enrollment, which means you have the opportunity to change you MCO partner. Fill out our MCO Open Enrollment form to select Sheakley UniComp as your MCO.

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