BWC is working with the medical community
As a member of the medical community, you play a
crucial role in BWC's efforts to provide benefits to Ohio's injured workers.
Under BWC's managed-care system, the Health Partnership Program (HPP), we work
together to provide our customers with the quality health care they deserve.
That's why we want to make sure you have the information you need to treat
injured workers safely and effectively.
HPP employs the medical management services of managed care organizations (MCOs). The MCO is responsible for:
The Qualified Health Plan (QHP) allows self-insuring employers to form their own health
care panels to deliver medical services to their employees. In QHP, you may contract
with the MCO or directly with the employer to provide services. Also in QHP, all terms
are negotiated with the employer. Financial arrangements cannot negatively impact the
quality of services provided.
- Reporting claims;
- Providing a diverse panel of certified health care providers;
- Medical case management including review of treatment requests and making treatment decisions;
- Dispute resolution – first level;
- Bill review and payment;
- Educating and assisting employers regarding safety and return-to-work initiatives.
The goal of HPP and QHP is to deliver high-quality, cost-effective health care for
injured workers. Through these programs BWC and our partners are committed to a system
that improves health care for employees and lowers cost for businesses by focusing on safe
and early return to work.
Provider enrollment and certification
Health care providers must be BWC-certified to participate in HPP or QHP. You may belong
to multiple MCO or QHP panels.
Provider enrollment and certification are ongoing. To enroll you must:
- Provide current license to practice;
- Provide valid Drug Enforcement Agency registration;
- Have no previous termination from BWC, Medicare or Medicaid programs;
- Have no felony convictions;
- Prove adequate malpractice coverage;
- Provide other specific provider-type requirements.
To become a BWC-certified provider, click here to download
and print the application. Fill in the information and mail it back to the address listed on
Promptness in reporting the claim is a must!
As a BWC-certified provider, you play an important role in the reporting of injuries.
When you are the initial servicing provider for an injured worker, you will need to
determine the correct MCO to report the claim. Some injured workers may know this
information from a previous claim or have a card from the employer that identifies
the MCO. If the injured worker doesn't know who the MCO is, you can assist them by
using the Employer/MCO look-up,
contacting the employer or calling BWC.
Reporting the claim is easy
You have two options to report an injury. You may report an injury to the appropriate
MCO within 24 hours or one business day of the initial treatment. The MCOs must
successfully transmit first reports of injury to BWC after you notify them. You may also
complete the First Report of Injury
form online and receive the claim number instantly. Please provide all information you've
gathered related to the injury or disease. This will facilitate a quick determination of
the claim and allow the MCO and BWC to process your bills and the injured worker's benefits
Communicating with the MCO
Communication between the servicing provider and the MCO is essential. The MCO
case manager will want to work closely with the provider's office to facilitate
appropriate treatment authorization,
and to coordinate rehabilitation efforts and
return-to-work goals by communicating with the provider and the employer.
The MCO Directory
is a great tool designed to assist providers in contacting and communicating with the MCOs.
The partnership continues
BWC is committed to working with our business partners to improve Ohio's workers
compensation system. We recognize that our goals are one and the same, to provide
the best possible service to our mutual customers, the injured workers and the
employers of the State of Ohio. If you have additional questions about Ohio’s
managed care programs, e-mail
BWC's medical management division or call 1-800-OHIOBWC and follow the options.