OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Interpreter and Translation Services

Policy #:

CP-09-03

Code/Rule Reference:

R.C. 125 and R.C. 4112

Americans With Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990); IC/BWC Joint Resolution R88-1-200

Effective Date:

07/23/20

Approved:

Ann Shannon, Chief of Claims Policy and Support

Origin:

Claims Policy

Supersedes:

Policy # CP-09-03, effective 11/14/16 and Procedure # CP-09-03.PR1, effective 11/14/16

History:*

Previous versions of this policy are available upon request


 

Table of Contents

 

I. POLICY PURPOSE

II. APPLICABILITY

III. DEFINITIONS

American Sign Language (ASL)

Interpreter

State Contracted Vendor

Translation

IV. POLICY

A.          Interpreters

B.          Translations

C.         State Contracted Vendor

D.         Self-Insuring Employers

V. PROCEDURE

A.          Standard Claim File Documentation

B.          Recognizing the Need for Interpreting Services

C.         Over-Phone-Interpreting Services

D.         On-Site Interpreter Services for BWC Exams

E.          ASL Interpreting Services

F.          Document Translation Services

G.         Hospital-Based Interpreter Services

H.         Interpreting Services for Catastrophic Claims

I.           Interpreter Services for IC Proceedings

J.          Interpreter Services Required by Vocational Rehabilitation

K.          Interpreter Services Required by the MCO

L.          Publishing a Decision

M.         Payment of Over-Phone-Interpreting and Document Translation Services

N.         Payment for On-Site Interpretation Services – BWC Exams, IC Hearings or Exams, or ASL Services

O.         Interpreting Services Paid from Surplus Fund

P.          Reporting Non-Compliance

 

 


 

I. POLICY PURPOSE

 

The purpose of this policy is to ensure that BWC provides interpreters for injured workers and employers and properly translates claim documents that are in a language other than English, as necessary and appropriate. 

 

II. APPLICABILITY

 

This policy applies to all claims services staff and managed care organization (MCO) staff.

 

III. DEFINITIONS

 

American Sign Language (ASL): A complete, complex language that employs signs made with the hands and other movements, including facial expressions and posture of the body, used primarily by people in North America who are hard of hearing.

 

Interpreter: An individual or device that converts any spoken material from one language into a different language. For purposes of this policy, the term “interpreter” includes both an ASL interpreter and a foreign-language interpreter, unless otherwise noted.

 

Limited English Proficiency (LEP): A person with Limited English Proficiency or LEP is one whose primary language is not English and is not able to speak, read, write or understand English well enough to communicate effectively when interacting with BWC staff.    

 

State Contracted Vendor: A person or company that has contracted with the Ohio Department of Administrative Services to provide selected products and services for use by state agencies and eligible users.

 

Translation: Conversion of written material from one language to another.

 

IV. POLICY

 

A.     Interpreters

1.     It is the policy of BWC to provide necessary and appropriate interpreter services upon the request of an injured worker (IW) or when the need is otherwise identified, to facilitate:

a.     Expediting treatment in catastrophic claims;

b.     Filing or investigating a claim or an action pending in a claim; or

c.      Medical specialist consultations requested by the physician of record (POR) or treating physician and approved by the MCO.

d.     Industrial Commission (IC) proceedings.

e.     Vocational rehabilitation services.

2.     ASL interpretation shall be approved and provided in these additional claim-related circumstances, including but not limited to:

a.     Routine office visits with a POR;

b.     Communication with durable medical equipment suppliers; and

c.      Physical or occupational therapy.

3.     BWC will not pay for interpreters:

a.     For hospital-based services;

b.     For services not contracted or approved by BWC or the IC; or

c.      When family members, friends, health care providers, vocational service providers, or community volunteers provide interpretation for the IW.

4.     It is the policy of BWC that any interpreter provided by BWC must be able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary appropriate to the circumstances.

 

B.     Translations

1.     It is the policy of BWC that a foreign-language document containing information relevant to making a claim decision be appropriately translated to English (e.g., letter from a surviving spouse; birth certificate of a dependent; marriage certificate of an IW).

2.     If the foreign-language document is relied upon to make a claim determination, BWC shall utilize the services of a professional translator that has:

a.     Native or near native fluency in the language being translated and in English; and

b.     Experience or expertise in the subject-matter of the document, adequate to provide a reliable translation (e.g., legal or medical terms).

 

C.  C.    State Contracted Vendor- It is the policy of BWC to use any state contracted vendor(s) to provide interpreter services whenever possible. For services outside the scope of the state term contract, claims services staff may use alternative providers, as outlined in the procedures below.

 

D.  D.    Self-Insuring Employers- Self-insuring employers are required to pay for interpreter and translation services, with the exception of interpreter services for examinations related to an Application for Determination of Percentage of Permanent Partial Disability (C-92).

 

V. PROCEDURE

 

A.     Standard Claim File Documentation

1.     BWC staff shall refer to the Standard Claim File Documentation and Altered Documents policy and procedure for claim note requirements; and

2.     Shall follow any other specific instructions for claim notes included in this procedure.

 

B.     Recognizing the Need for Interpreting Services

1.     When claims services staff becomes aware that an IW is LEP or is hearing impaired, claims services staff shall:

a.     Check the “Primary Language” field at the customer level of the claims management system; and

b.     Choose the IW’s primary conversational language from the dropdown box.

2.     Identifying an Interpreter and Arranging Services

a.     Claims services staff may work with the state contracted vendor or other service providers to obtain services, as outlined in this procedure.

b.     If the IW requests that a family or friend provide interpreting services, BWC may consider utilizing those services.

c.      When reasonable and effective interpreting services cannot be provided by the IW’s family or friends, claims service staff may also investigate other resources that may be available at no additional cost to BWC. Such resources may include:

i.       Bilingual staff at the Customer Contact Center;

ii.      Telecommunications Relay Service (Ohio Relay Service dial 7-1-1);

iii.      A health care or vocational rehabilitation service provider fluent in the language of the IW. (NOTE: The health care provider or vocational rehabilitation service provider will not be additionally reimbursed for interpreter services); or

iv.    Community organizations.

d.     Choice of interpreting services shall be made by BWC utilizing BWC’s policy objective that interpreters must be able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary appropriate to the circumstances.

 

C.  C.    Over-Phone-Interpreting Services- Claims services staff shall contact the state contracted vendor to obtain these services. Click “here” for instructions.

 

D.  D.    On-Site Interpreter Services for BWC Exams– Claims services staff shall:

1.   Contact the state contracted vendor to schedule these services. Click “here” for instructions.

2.   Provide the state contracted vendor 48 hours to report confirmation (e.g., verbal, email) that an interpreter has been scheduled for the exam.

a.   If confirmation is received, claims services staff shall document the confirmation number in notes.

b.   If no confirmation is received, claims services staff shall contact:

i.    Feedback.medical@bwc.state.oh.us for a list of BWC interpreting service providers to schedule an interpreter for the exam; and

ii.   Field.C.1@bwc.state.oh.us to report non-compliance.

 

E.     ASL Interpreting Services

1.     ASL services are not provided by the state contracted vendor.  In cases where an ASL interpreter is needed, claims services staff shall contact Feedback.medical@bwc.state.oh.us for a list of service providers.

2.     Claims services staff may contact Field.C.1@bwc.state.oh.us with questions or inquiries on the ASL services.

 

F.     Document Translation Services

1.     Claim services staff shall obtain a translation of documents written in a foreign language that appear to be:

a.   Communications from, or on behalf of, a party to the claim; or

b.   Evidence in a claim.

2.   Claim services staff may consult with a bilingual BWC staff member regarding a document to determine the nature of the document and its general contents.

3.   If the document appears to provide information or evidence upon which a claim decision will be made, claims services staff shall contact Feedback.medical@bwc.state.oh.us for a list of service providers to translate the document(s). Translation of foreign documents to English is not a service provided by the state contracted vendor.   

4.   Claims services staff shall ensure the translation is imaged into the claim file.

5.     Claims services staff may contact Field.C.1@bwc.state.oh.us with questions or inquiries on the document translation services.

 

G.    Hospital-Based Interpreter Services

1.   Hospital-based interpreter services for an LEP IW:

a.   Will not be paid when associated with treatment an IW receives while hospitalized.

b.   Will be paid if BWC needs to communicate with the IW and the IW requires an interpreter.

2.   Caims services staff shall note the IW’s need of interpreter services in the claim file.

 

H.    Interpreting Services for Catastrophic Claims

1.     The BWC catastrophic nurse advocate shall work with the MCO to review available options when interpreter services are necessary.

2.     This communication can be accomplished by phone or email and noted in the claim file.

 

I.       Interpreter Services for IC Proceedings

1.     LEP or hearing impaired IWs may require an interpreter so that the IW can understand what is happening in IC hearings.

2.     If the claims services staff is referring an issue to the IC on a Notice of Referral (NOR) or there is an appeal to a BWC order, claims services staff shall ensure the “Primary Language” field is marked in the claims management system, which will automatically alert the IC that the IW needs interpreter services.

3.     Consistent with IC/BWC Joint Resolution R88-1-200, the IC is responsible for ordering and scheduling interpreters for IC hearings and IC medical examinations for IWs who have difficulty communicating due to a hearing impairment or limited English proficiency. Claims services staff shall refer any questions regarding interpreter services for IC hearings or IC medical examinations to IC Customer Service for assistance.

 

J.      Interpreter Services Required for Vocational Rehabilitation

1.     Claims services staff shall ensure that an IW receives necessary and appropriate interpreter services, particularly at critical stages in the rehabilitation process, including, but not limited to:

a.   The initial interview with the IW;

b.   The meeting to discuss and sign the rehabilitation agreement;

c.   When the plan expectations are discussed; and

d.   When there is a change in the case direction.

2.     BWC Vocational Rehabilitation Policy staff will be available to help in individual cases, upon request.

 

K.     Interpreter Services Required by the MCO

1.     If an IW needs an interpreter for a non-BWC examination that is required and scheduled by the MCO, the MCO is responsible for payment of both the examination and the interpreter services. The MCO may use its own interpreter service or may request assistance from BWC or the IC, as applicable.

2.     If the IW needs interpreter services related to an Alternative Dispute Resolution (ADR) examination, the MCO will contact the IW’s assigned CSS or DMC to make the arrangements. BWC will pay for interpreter services for ADR examinations as often as necessary.

3.     Staff shall place a note in the claim reflecting the discussion with the MCO and their agreement as to the entities responsible for payment.

4.     If an MCO approves interpreter services in error, without BWC approval, the MCO shall be responsible for reimbursement to the provider. Payment will be transferred from the MCO’s administrative account into the provider account to cover the exact payment issued from the provider account to pay for the interpreter services. Supporting documentation for the transaction must be maintained for audit purposes.

 

L.     Documenting a Decision - Claims services staff shall enter a claim note which includes the following details:

1.   Approval of the request;

2.   The specific type of interpreter being approved (e.g., ASL interpreter, over the phone, on-site, or document translation services);

3.   The date and event approved for interpreter services; and

4.   The name and contact information of the service provider.

 

M.    Payment of Over-Phone-Interpreting Services

1.     Once over-the-phone services are provided, the state contracted vendor will create an invoice for that service and email the invoice to Ohio Shared Services for payment processing and copy Claims Services Administration. 

2.     Claims Services Administration will review the invoice to determine if they should approve or reject the invoice for payment. If the invoice is:

a.   Approved, Claims Services Administration will notify Accounts Payable via email that the invoice is approved and should be processed.

b.   Rejected, Claims Services Administration will notify Accounts Payable via email that the invoice is rejected with the underlying reason(s). Ohio Shared Services will return the invoice back to the state contracted vendor with the reason for the rejection (e.g. duplicate invoice, or invoice is missing necessary information).

3.     Ohio Shared Services will not pay invoices without the proper approval from BWC.

 

N.    Payment for On-Site Interpretation and Document Translation Services

1.     BWC will pay for approved on-site interpretation (including ASL services) for BWC and IC examinations, and for IC hearings as well as document translation services.

2.     The interpreting service provider or IC shall submit the request for reimbursement for services on a C-19 to BWC.  Imaged C-19s will appear on the Medical Billing and Adjustments (MB&A) Unit’s work list.

a.   When MB&A receives the C-19 directly:

i.    MB&A shall review the claim for the claim note approving interpreter or translation services.

ii.   If MB&A is unable to locate adequate documentation of approval by the claims services staff in the claim, MB&A shall forward the C-19 to either the claims services staff or Claims Services Admininstration, requesting the necessary information so that payment may be processed.

b.   When claims services staff receives the C-19, either directly from the provider or from MB&A, claims services staff shall:

i.    Verify that the services were provided and the information is correct;

ii.   Place his or her “A” number in Box 9 on the completed C-19 before it is imaged;

iii.   Index the document as a C-19; and

iv.  Update the approval in claim notes.

c.   MB&A will also process for payment all interpreter service invoices received from the IC.

d.   BWC shall not pay for interpreter services that are not approved by BWC or the IC.

 

O.  O.    Interpreting Services Paid from Surplus Fund

 

1.     Payment for interpreter services shall be made from the Surplus fund.

2.     Non-complying employers shall be billed for payments made from the Surplus fund in no-coverage claims.

3.     Examinations related to an Application for Determination of Percentage of Permanent Partial Disability (C-92) in self-insuring employer claims shall be made from the Surplus fund.

 

P.   P.     Reporting Non-Compliance - Claims services staff shall report state contracted vendor non-compliance or other issues to Field.C.1@bwc.state.oh.us.