Managed Care

The Role of an MCO

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Published on May 17

MCOs are required to evaluate the current and future medical needs of injured workers by approving treatments, paying medical bills, and providing rehabilitation referrals. However, the role of an MCO often goes far beyond these tasks. Here is a look at the role MCOs, like Sheakley UniComp, play in the management of your workers’ compensation claims.

What is an MCO?

MCOs perform a wide variety of functions, these duties allow them to medically manage your workers’ comp claims. Being involved in each step allows your MCO to look out for the best interests of your company and your injured worker.

Since the Ohio Bureau of Workers’ Compensation (BWC) requires all employers to select an MCO when they first apply for workers’ compensation insurance, the fees for the MCO are paid out of the employer’s premium for each year. MCOs are responsible for obtaining the First Report of Injury (FROI), initial claim data, medical records for the BWC, managing and paying all medical provider bills, and ensuring all fees are appropriate for the claim. Additionally, the MCO authorizes and denies all medical treatment requests, coordinating with the medical care provider to facilitate the safe and timely return to work of injured workers.

The BWC and your MCO work together to manage workers’ comp claims and coordinate medical services, with an emphasis on returning injured workers to work safely and efficiently. Every two years, during an open enrollment period, employers may select a new MCO to work with or continue with their current MCO. This year MCO open enrollment begins May 3rd and ends May 28th.

Filing and managing claims

One of the most important functions of your MCO is filing and managing all workers’ comp claims on behalf of your company and the injured worker. Sheakley UniComp manages the medical portion of all of your workers’ comp claims, ensuring your injured workers receive the quality medical care they deserve and, can return to work safely.

To make the management of all claims a little easier, Sheakley UniComp assigns a team of skilled associates to your company. Your MCO maintains an open line of communication with your company, supplying claim updates, suggesting training and safety programs that can help limit the number of future injuries, and other information.

Approving the injured worker’s treatment

When an employee is injured on the job, the most important first step is ensuring that the worker receives timely and efficient treatment. Delays in treatment or treatments that are unnecessary can add costly delays and excessive costs to the total claim costs.

Sheakley UniComp works with the medical providers, occupational and physical therapists, and others involved in the treatment of the injured worker to ensure that the worker is receiving the treatment they need. Sheakley UniComp’s case managers ensure that all treatments are customary for the type of injury. Staying in contact with all providers throughout the treatment process enables Sheakley UniComp to facilitate the timely treatment and safe return to work of your injured workers.

Paying the injured worker’s medical bills

The BWC places the responsibility of processing and paying all medical bills on the MCO. When processing the payment of workers’ compensation medical bills, Sheakley UniComp not only conducts a review of all bills to ensure that the fees and costs are customary for the worker’s injury, but also utilizes its extensive medical provider network to access cost-saving opportunities.

Being actively involved in the claims process and monitoring all medical bills allows the MCO to help control costs associated with each claim. Sheakley UniComp’s bill processors ensure that only those services, treatments, and medicines actually provided are billed and that the costs billed are customary and fit within the BWC fee schedule.

Providing Return-to-work services

No matter the injury, Sheakley UniComp approaches every claim with the goal of returning the injured worker to active employment as soon as possible. Whether modified-duty, transitional work assignments, or non-profit return to work assignments, identifying these opportunities is essential to reducing the cost of claims and to reduce the likelihood that the claim will develop into a total disability claim.

Lost time claims can have a significant impact on your workers’ compensation premiums. Sheakley UniComp consistently strives to return injured workers to the job as soon as they are medically cleared. Not only do these efforts help save your company money, but they also set your employees up for post-injury success by reducing downtime.

Providing a network of providers

Working with our dedicated network of providers, Sheakley UniComp offers our clients access to cost savings below the BWC fee schedule. When employers choose to work with Sheakley UniComp, the physicians in our provider network are able to offer discounts that are unavailable to those outside the network.

When selecting an MCO partner, employers should ensure that they will have access to a large, quality provider network to meet the needs of their employees. Sheakley UniComp’s provider networks offers discounts of up to 20% below the BWC fee schedule while delivering top-notch service from highly-qualified physicians.

Partnering with the right MCO is essential, and while Open Enrollment is in full swing, be sure your MCO is fulfilling all these roles. To select Sheakley UniComp as your MCO partner, fill out our enrollment form, or learn more about Sheakley UniComp.

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