Every two years the Ohio Bureau of Workers’ Compensation (BWC) provides employers an opportunity to evaluate the performance of their current Managed Care Organization (MCO). MCOs are responsible for the medical management of workplace injury claims, including initial injury reporting, assisting with medical treatment, paying medical bills and helping achieve successful return to work outcomes.
If an employer feels they are not receiving an appropriate level of service, every other year they have the opportunity during the month of May to make a change in their MCO. Once an open enrollment period ends, an employer’s MCO selection will stand for the next two years. Employers opting not to change MCOs will automatically remain with their current MCO for the next two years.
While employers do not directly pay for the services of their MCO, there are several MCO responsibilities that can impact the premium employer’s pay to BWC.
This is a time when employers should be asking some core questions about their current MCO, including:
- Does my MCO make it easy to report new claims?
- Does my MCO provide injury reporting packets?
- Does my MCO assist with identifying initial treating providers so my injured employees can receive quality medical treatment with a return to work focus?
- Does my MCO provide online access to claims information and documents?
- Does my MCO process medical bills timely and accurately?
- Does my MCO collaborate with me and my Third Party Administrator (TPA) to ensure successful claim outcomes?
CareWorks is the endorsed MCO of ERC and currently provides all of the above services to many ERC members. CareWorks assists our clients with their workers’ compensation claims by customizing our services around the unique needs of each individual client.
CareWorks is the most selected Ohio MCO, representing approximately one third of all claims filed with BWC in 2015. Their experience across all industries puts us in a unique position to properly manage claims and create positive outcomes. (Source: BWC 2015 MCO Report Card and public information request received from BWC on 1/20/2016 providing totals of all claims filed with BWC with date of injury in 2015, compared to CareWorks data showing claims reported for same period.)
From establishing good reporting practices to making personal visits to physicians to discuss difficult claims, CareWorks works diligently to assist our clients with reducing the negative impact of workers’ compensation claims.
BWC has announced that the 2016 MCO Open Enrollment period will be held from May 2, 2016, to May 27, 2016. Current CareWorks customers need not do anything during the MCO Open Enrollment, they will be automatically re-enrolled with CareWorks.
Absence Management & FMLA Administration
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