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OhioBWC - Provider - Service:  (Billing and Reimbursement Manual)

Billing and Reimbursement Manual

All BWC-certified providers should have a copy of BWC's Billing and Reimbursement Manual. The manual explains the billing procedures for medical providers, who are treating injured workers under the Health Partnership Program.

Note: Should you have arrived on this Web page as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the materials unless you read, agree to and abide by the provision of the copyright statement. Read the copyright statement now.

IMPORTANT: As we continue the transition to ICD-10, we will need to update our policy and billing reference materials. We will make those updates as we convert specific policies to our technical format. In the meantime, treat any references to ICD-9 in these documents as ICD-10.

For your convenience, you can download and print a specific chapter or the entire manual from this Web page. The free Adobe Reader software is required to display and print publications that are available for viewing online. To download a specific chapter, click on the chapter title. If you want to download the entire manual, click on each chapter title and download each chapter one at a time.

Chapter 1 – Ohio Bureau of Workers' Compensation System
This chapter includes information about employer types; managed care organization roles/responsibilities; provider eligibility; reporting an injury; guidelines for treatment, coding and reimbursement; and other BWC processes and procedures.
Presumptive approval guidelines
MCO standard prior authorization table
Medical documentation policy

MCO Directory

Chapter 2 – BWC Local Level Coded Services
Chapter 2 - CPT Surgical Indicators
This chapter includes information about Centers for Medicare and Medicaid Services (CMS) and CPT codes.

Chapter 3 – Services
This chapter includes information about practitioners, hospitals, ambulatory surgical centers, outpatient medication, vocational rehabilitation, home health agencies, nursing homes and other BWC-certified provider services.

Chapter 4 – Billing Instructions
This chapter includes information about billing rules and laws, instructions for completing BWC billing forms and a guide for explanation of benefits.
Outpatient Medication Invoice (C-17)
Service Invoice (C-19)

Policy alerts
BWC will periodically issue policy alerts to provide further clarification on specific policies. To download the latest policy alerts, click here.