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OhioBWC - Basics:  What is HPP?

What is HPP?

Managed Care Comes to Ohio

Bringing high-quality, cost-effective workers' comp health care to the employers and employees of Ohio!

On March 1, 1997, BWC changed how it manages state fund workers’ compensation claims. BWC is still responsible for the overall management of the claim file and the MCOs are responsible for the medical management of the claim.

The Health Partnership Program (HPP) and the Self-Insured Qualified Heath Plan (QHP) ushered in a new era in health care for Ohio's injured workers. Through the combined efforts of BWC, businesses, organized labor and health-care providers, we've created a workers' compensation managed-care system we hope will meet our customers' needs for years to come.

HPP is truly a partnership, BWC and the private-sector managed care organizations (MCOs) certified to participate in HPP must work together to provide comprehensive claims-management and medical-management services.

BWC is responsible for:

  • Claim determinations and allowances;
  • Paying lost time compensation;
  • Second level of dispute resolution;
  • Educating injured workers, employers and providers about HPP.

MCOs are responsible for:

  • Provider management;
  • Utilization review;
  • First level of dispute resolution;
  • Determining reimbursement eligibility and paying providers for services;
  • Educating injured workers, employers and providers about HPP.

To help you better understand how our managed-care system works, we've provided a list of basic questions and answers.

Q: What is HPP?
A: HPP is the Health Partnership Program, an innovative plan designed to provide quality medical care for Ohio's injured workers.

Q: What is QHP?
A: QHP is the Qualified Health Plan, which allows self-insuring employers to form their own health plans to deliver medical services to their employees.

Q: What is the difference between HPP and QHP?
A: HPP and QHP are both managed-care programs designed to provide quality medical management services. HPP is the managed-care program for state-fund employers. QHP is the managed-care program for self-insuring employers. HPP design is the result of the partnership between BWC and the stakeholder community. QHP was developed by a Governor-appointed panel known as the Health Care Quality Advisory Council (HCQAC). HPP and QHP operate under the authority of separate rules.

NOTE: HPP will not affect fee bills for Marine Fund or Black Lung claims, family caregivers, and BWC/IC examinations. BWC retains responsibility for payment of these services.

The self-insuring employer is responsible for authorizing and determining medical necessity in self-insuring employers’ claims. The provider of record is responsible for contacting the appropriate self-insuring employer for authorization guidelines. Fee bills and medical documentation are sent directly to the self-insuring employer. Self-insuring employers may choose to form their own Qualified Health Plans (QHP) to deliver medical services to their employees, however, they are not required to do so.

If your employer is participating in the Health Partnership Program (HPP), you can expect:

  • Higher quality medical care;
  • Timely access to medical services;
  • Choice of any BWC-certified health-care provider. In an emergency or initial visit, any provider is covered by HPP;
  • If your claim's date of injury is prior to Oct. 20, 1993, you may continue to see that provider regardless of certification. However, if you change doctors you must choose a BWC-certified provider;
  • 100-percent coverage of an allowed claim's medical costs;
  • No co-pays;
  • To receive a card that will identify your employer's MCO to providers;
  • Your MCO, your employer and BWC to provide training.