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OhioBWC - Provider:  Managed care information

Managed care information

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:

  • 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 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.

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 the application.

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 sooner.

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.


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