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OhioBWC - Basics: (Policy library) - File

Policy and Procedure Name:

Interpreter and Translation Services

Policy #:

CP-09-03

Code/Rule Reference:

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:

11/14/16

Approved:

Rick Percy, Chief of Operational Policy, Analytics & Compliance (Signature on File)

Origin:

Claims Policy

Supersedes:

Policy and Procedure CP-09-03, with an effective date of 10/03/16.

History:

Rev. 10/03/16; 11/05/14; 07/08/13; New 10/15/12

Review date:

10/03/19

 

 

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 Field Operations 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.

 

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 managed care organization (MCO).

2.    ASL interpretation only, shall be approved for claim-related:

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 Industrial Commission (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).

 

V. Procedures

 

A.    Interpreter Services

1.    If at any time during the life of a claim, field staff becomes aware that an IW is incapable of communicating in English, field staff shall:

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

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

2.    Processing a Request for Interpreter Services

c.    The CSS or DMC shall address a request for interpreter services promptly to prevent any delays in services.

d.    The CSS or DMC shall notify parties to the claim and any applicable service provider of approval or denial of interpreter services via the Interpreter Services Approval/Denial letter.

e.    If the CSS or DMC has not received the request for an interpreter until shortly before the interpreter is needed, and the Interpreter Services Approval/Denial letter is not likely to be received timely, the CSS or DMC shall contact the parties by telephone to notify them of the decision, in addition to sending the letter.

f.     The letter shall include notice that if a party to the claim objects to the decision, he or she may file a Motion (C-86).

g.    The CSS or DMC shall enter a claim note which includes the following details:

i.      Approval or disapproval of the request;

ii.     If approved, the specific type of interpreter being approved (e.g., ASL interpreter, Spanish interpreter);

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

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

3.    Identifying an Interpreter, Arranging Services and Payment

a.    When reasonable and effective interpreting services cannot be provided by the IW’s family or friends, the CSS or DMC shall investigate other resources available that have no additional cost to BWC. Such resources may include:

i.      Bilingual staff at the Customer Contact Center;

ii.     Bilingual staff identified on BWC’s internal website;

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

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

v.    Community organizations.

b.    If the CSS or DMC determines an interpreter service provider is necessary, the CSS or DMC shall:

i.      Determine if there is a provider with a state contract identified on COR. If so, the CSS or DMC shall contact that provider first.

ii.     If a state contract provider is not identified on COR or is unable to provide the necessary service, the CSS or DMC shall reference the “Interpreter Services Enrolled Providers” list on COR.

c.    If the need cannot be sufficiently met using a state contract provider or an enrolled provider, but an interpreter has been otherwise identified (e.g., the IW or the IW’s attorney has identified an interpreter), the CSS or DMC shall assist the provider with enrollment.

i.      The CSS or DMC shall send or direct the provider to the Application for Provider Enrollment Non-Certification (Medco-13A) form available on COR and in the medical provider forms section of www.bwc.ohio.gov.

ii.     The CSS or DMC shall then communicate the following information to the BWC Provider Relations section:

a)    The name and telephone number of the provider applying for enrollment;

b)    Approval of the provider by the CSS or DMC; and

c)    The IW’s name and claim number;

iii.    BWC Provider Relations will enroll the provider and send an email to the CSS or DMC confirming enrollment.

iv.   The CSS or DMC shall provide BWC payment instructions to the approved interpreter provider.

d.    Upon request, members of Claims, Medical or Vocational Rehabilitation Policy shall be available to staff cases with the CSS or DMC to assist in determining what interpreter services are necessary and appropriate and to identify an appropriate provider.

e.    In cases of catastrophic claims, the catastrophic nurse advocate shall work with the CSS or DMC to review available options and determine whether interpreter services are necessary.

f.     Once a provider is identified, the CSS or DMC shall make the appropriate arrangements for the interpreter services.

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

i.      If the employer is non-complying, interpreter services costs shall be recouped from the employer.

ii.     If the employer is self insuring (SI), the SI employer shall pay for any needed interpreter services, except for interpreter services for examinations related to an Application for Determination of Percentage of Permanent Partial Disability (C-92), which shall be paid from the Surplus fund.

h.    Payment for interpreter services shall be made pursuant to a Service Invoice (C-19), completed by the provider.

i.      If Medical Billing and Adjustments (MB&A) receives the C-19 directly:

i.      MB&A shall review the claim for the claim note and letter approving interpreter services;

ii.     If MB&A is unable to locate adequate documentation of approval by the CSS or DMC in the claim, MB&A shall forward the C-19 to the CSS or DMC, and copy the CSS or DMC’s supervisor, advising the CSS or DMC to provide the necessary information so that payment may be processed.

j.      Upon receipt of the C-19, either directly from the provider or from MB&A, the CSS or DMC 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.

k.    The C-19 will appear on the MB&A work list.

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

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

4.    Hospital-Based Services

a.    If an IW has been approved for hospital-based services and the CSS or DMC is aware that the IW will require interpreter services, the CSS or DMC shall notify hospital social services or another hospital department designated for obtaining interpreters of the need.

b.    The CSS or DMC shall also request that the hospital notify him or her if interpreter services will be required soon after the IW is discharged, to prevent interruption of care and facilitate return to work.

5.    Interpreter Services for Industrial Commission (IC) Proceedings

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

b.    Consistent with IC/BWC Joint Resolution R88-1-200, the IC is responsible for ordering and scheduling interpreters for IC related hearings, medical examinations, or for other similar circumstances involving individuals who could not otherwise communicate due to a hearing impairment or limited English proficiency. The CSS or DMC shall refer any questions from parties to the claim to IC Customer Service for assistance.

6.    Interpreter Services Required by Vocational Rehabilitation

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

i.      The initial interview with the IW;

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

iii.    When the plan expectations are discussed; and

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

b.    BWC Vocational Rehabilitation Policy staff will be available to help staff cases, upon request of the DMC.

7.    Interpreter Services Required by the MCO

a.    If an IW needs an interpreter for an 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.

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

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

d.    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.

 

B.    Translation Services

1.    The CSS or DMC shall obtain a translation of documents that appear to be:

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

b.    Evidence in a claim.

2.    The CSS or DMC 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, the CSS or DMC shall arrange for a professional to provide a translation.

a.    The CSS or DMC shall reference COR to determine if there is a provider with a state contract available to provide the service.

b.    The CSS or DMC may staff with the supervisor, and/or other BWC staff when needed, to provide direction on obtaining document translation.

c.    The CSS or DMC shall ensure the translation is imaged into the claim file.


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