What is a managed care organization?
An MCO is a private company that an employer contracts to medically manage the workers’ compensation claims for injured employees. MCOs are an integral part of the Ohio Bureau of Workers’ Compensation’s Health Partnership Program (HPP).
How do I file a claim?
If you become injured on the job, seek immediate treatment at the nearest medical facility. You should notify your supervisor of the injury as soon as possible and contact (or ask your supervisor to contact) CompOne to file a First Report of Injury form. If you need additional medical care, CompOne will direct you to the appropriate medical provider.
How long does it take to process my claim?
Immediately after receiving the First Report of Injury form, the BWC begins the process of gathering information and investigating the claim. A decision will be made to allow or deny the claim within 28 days.
Who is responsible for obtaining the needed information to allow my claim?
CompOne serves as the link between the BWC and the healthcare provider in obtaining and sending medical information. CompOne will handle the medical management of your claim; however, we do not make the decision to allow or deny a claim. This is a BWC function, and you will be notified via mail. CompOne does make the treatment reimbursement decisions, bill payment and rehabilitation referrals.
Can I go to any doctor I want?
You do have freedom to choose your physician of record for your claim; however, your chosen physician must be BWC certified.
How do my medical bills get paid?
Once the claim is allowed, the providers (other than pharmacies) who have treated you for the work-related injury should submit their bills to CompOne. We will review and price the bills and forward them electronically to the BWC. The BWC pays CompOne, and we will in turn disburse payment to the providers.
Will I be compensated for my prescriptions?
If your claim is ultimately allowed, the BWC will reimburse you directly for the cost of your prescriptions. The amount you will pay for your prescriptions is considered a co-payment and is less than what you would pay as a cash customer.
Do I have to have an MCO?
Yes. Employers are required to select an MCO. Employers who do not select may have an MCO randomly assigned to them.
What should I do if one of my employees becomes injured on the job?
Advise the employee to seek medical attention immediately. Call CompOne as soon as possible at 1-877-281-9821 to report the injury.
What should I do if an employee’s injury prevents him or her from returning quickly to the job?
CompOne will work with you to create a plan of action to return the injured worker to the workplace with possible resolution of claims. Communication with the employee and your MCO is key to work toward resolution of the claim. Whether it be on-site therapy, modified duty, provider intervention, wage continuance – let us work with you to try to keep that claim from becoming “lost time.”
Is there a time limit for report of a worker’s injury?
Yes. Providers must report injuries and provide medical documentation within 24 hours from the time the injured worker was examined at your facility. Providers must also submit a Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) treatment plan to CompOne for the services performed.
What form is used for additional allowances?
Physicians may request that an additional diagnosis be added to a claim by completing the C-9 and noting the requested diagnosis in Section 6 of the form.
How long does it take for an additional condition to be added?
Between five and 28 days of the receipt of the recommendation, the BWC will notify the provider, CompOne and all parties of the decision in writing.
How do I request authorization for non-emergency medical services or if I have already treated the injured worker?
Providers must complete and submit the C-9 form to CompOne. We will respond to retroactive requests for authorization within 30 days of receipt.
Are there time frames for addressing the C-9?
CompOne must respond to the physician within three business days. If we are unable to make a decision within three business days due to the need for additional information, we will send a Request for Additional Medical Documentation for C-9 (C-9-A). We then have five business days from the date additional information is received to make a subsequent decision.
How are medical bills paid?
Medical bills must be submitted to CompOne. We will review, price and submit the bills to the BWC. The BWC will further review the bills and remit payment to CompOne. We will then reimburse the provider.