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OhioBWC - Basics: (Policy library) - File

InfoStation Document

MCO Notes

Notes are a chronological record of events and activities in a claim.  Accurate notes reflect the progress of the claim and provide a quick and easily accessible summary of claim activity.  As part of the New Business Model and Claims Staffing process, all claims management services are going to be integrated on Customer Care Teams.  These integrated services include claims specialists, employer management, injury management support and MCOs.   As part of the integration of services process, MCOs will submit their notes to BWC.  Initially, notes were be viewable to only BWC and MCO staff . Effective Jan. 18, 2005, MCO notes became available for viewing by authorized providers and external parties to the claim.  Both MCO and BWC notes are currently subject to public records laws. 

 

Submitting Notes to BWC

Effective Oct. 18, 2004, MCO notes created from that date forward will be shared with BWC for BWC viewing through V3 notes. MCO notes created before Oct.18, 2004 will not be sent to BWC.  MCOs must have a daily process for submitting notes.  MCO notes must be submitted within one business day of creation.  In the case of new claims, notes must be submitted within one business day of claim number receipt.  Notes submitted with a creation date more than 10 calendar days prior to the submission date will be rejected.

 

MCOs should not send notes received from previous MCOs (i.e. notes from claims transferred through open enrollment or policy number changes).  Previous MCO notes should have already been submitted and viewable via V3 and Dolphin.

 

Notes related to Fraud should not be submitted in the MCO Notes file.  The MCO should follow established processes for reporting suspected Fraud.

 

MCOs will continue to enter notes according to their medical management policies and procedures as required by URAC with four notable exceptions:

1.    If an MCO or BWC staff name is used in the notes, it should only contain first name and last initial.

2.    Notes should not contain the BWC servicing  provider number as BWC sometimes assigns a servicing provider number to an individual provider based on his/her social security number with a two digit (-00) suffix.  Care should be taken in documenting phone numbers and fax numbers.

3.    Existing notes can not be appended after they have been submitted to BWC.  A new note will need to be created because each note will have a system assigned unique identifier when it is submitted to BWC.

4.    Cutting/copying and pasting content from e-mails into notes is quick and convenient. However, to ensure consistency and easy understanding for all parties reading the note, the following guidelines must be followed:

·         Identify the author of the  e-mail - be sure to only use first name and last initial;  

·         Explain why the e-mail is pasted in notes;

·         To avoid duplicates, make sure the content from the e-mail is new information not already available in V-3 notes (BWC entered) or imaging.

 

BWC uses titles for the V3 notes, however, MCOs are not required to do so.  The title in V3 when a note is submitted without a title will be “MCO Note Sent Without Title.”

 

Quality Assurance

Accurate notes reflect the progress of the claim and provide the reader with a quick and easily accessible summary of claim activity. Notes should be written in a professional manner and contain objective statements, such as facts and actions and observable behaviors, without bias. Notes should not contain subjective statements, such as opinions, perceptions or drawn conclusions. MCO notes must provide evidence that the injured worker, provider and employer have been contacted to create a RTW plan.

 

During the transition period Oct – Dec. 2004, notes were reviewed by BWC for compliance with policy related to appropriateness and 10 day submission period. MCO notes became viewable to external parties to the claim via Dolphin on Jan. 18, 2005.

 

As a general guideline, notes should:

·         Contain only factual information. They will not include editorials or hearsay.

·         Be written in a logical and sequential order.

·         Be direct and to the point. The use of jargon and abbreviations should generally be avoided.

·         Only contain information that is relevant to the claim.

·         Contain an explanation of any decisions made by the MCO.

·         Be entered the same day as the action being described.

·         Cite all contacts. BWC contacts (e.g. team nurse) should be cited by first name and last initial (e.g. John D. for John Doe).  MCOs have the option of citing their staff names by first name and last initial.  External contacts should be cited by first and last name along with their relationship to the IW or employer (e.g. Called IW and spoke to John Doe, the IW’s brother.)

·         Not contain BWC servicing provider numbers.  Care should be taken in documenting phone numbers and fax numbers.

·         Not duplicate information from a previous note submitted to BWC.

·         Contain proper English and grammar.

·         Each note should be informative, accurate and easy to understand.

 

Viewing MCO Notes

The MCO notes are loaded intoV3 notes in BWC received date order.  During the transition period, after the MCO notes were loaded in V3, V3 users, BWC Internal Dolphin users, the Industrial Commission and Attorney General’s office had access to view MCO notes.  The MCO also had access to view their notes through Dolphin. Authorized providers and external parties gained access to view MCO notes on Jan. 18, 2005.  The MCO Notes appear in V3 and Dolphin as text only.  MCO notes do not necessarily display in the same format as it appears on the MCO system.   MCO notes are accessible on EDA. 

 

Deleting MCO Notes

After the MCO notes have been successfully loaded in V3, all V3 users will have access to view the note.  Upon viewing the MCO’s notes, if the Customer Care Team Manager (CCT) determines that the note(s) may be inappropriate, the issue will be referred to the SOM for review.  If the SOM review agrees that the note is inappropriate,  the V3 Support Team Manager will be contacted to review the note(s) and determine if the note needs deleted. 

 

Currently, BWC does delete selected notes from V3, however, it is not a common occurrence.  The determination of an inappropriate note is not based on spelling or grammar errors.  Rather, it is deleted because it contains references that are unprofessional, can be construed as inflammatory or harmful to an individual, not related objectively to the management of the claim or reflect personal feelings regarding a contact that has been made.  The  V3 Support Team Manager, the MCO Business Council Representative and MCO Business and Reporting Unit Representative will coordinate the determination to delete a note.

 

Rejected MCO Notes

If a note is rejected because the MCO no longer manages the claim, the MCO must ensure that substantive information is communicated to the new MCO.  If a note is rejected because the claim has been combined, the note under the surviving claim should be resubmitted if it contains substantive information.

 

Notes submitted with a creation day more than 10 calendar days prior to the submission date will be rejected and should be resubmitted according to the procedures detailed in the Information Systems Documentation.

 


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