MCO Open Enrollment is Open through May 27

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MCO Open Enrollment

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.
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Workers’ Compensation Claims: Strategies for Optimal Outcomes

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Workers’ Compensation Claims: Strategies for Optimal Outcomes

By utilizing workers’ compensation best practices employers can achieve a higher level of control over their workplace injuries, which can result in reduced severity and claim costs and better outcomes.

Early Reporting & Transitional Work

Early claim reporting is a crucial first step in controlling costs.  Numerous national studies have shown the longer it takes for a claim to reported, the costlier the claim.  That’s why it’s important to work with an Ohio Managed Care Organization (MCO) that has efficient options for reporting new workers’ compensation claims.  These can include fax, telephone, online or email reporting.
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Workers Compensation Best Practices for Employers

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Workers Compensation Best Practices for Employers

By utilizing workers’ compensation best practices employers can achieve a higher level of control over their workplace injuries, which can result in reduced severity and claim costs and better outcomes.

Early Reporting & Transitional Work

Early claim reporting is a crucial first step in controlling costs.  Numerous national studies have shown the longer it takes for a claim to reported, the costlier the claim.  That’s why it’s important to work with an Ohio Managed Care Organization (MCO) that has efficient options for reporting new workers’ compensation claims.  These can include fax, telephone, online or email reporting.
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An Important Enrollment

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By Pat Perry

Next week, the Ohio Bureau of Workers’ Compensation is providing a one month open enrollment for employers relative to selecting a Managed Care Organization (MCO). MCOs are a key player for many organizations in keeping their workers’ comp costs in control through proactive case management and a solid transitional work program. Employers pleased with their MCO do not need to take any action. Employers seeking a new MCO can do so at no cost and it only takes about 5 minutes.

There is plenty of information about MCOs at the Bureau’s web site and more data about Ohio MCOs will become abundant starting next week. If you do not know your company’s MCO, you can simply click here to find the MCO assigned to your organization.

Over the next several weeks, ERC will be providing information about the MCO selection process and other critical data to provide organizations facts upon which to make an informed decision. As this open enrollment only occurs every two years, this decision is extremely important.

Since the MCO Open Enrollment period starts April 30 and ends May 25, we will continue to provide you with information throughout to assist you in your choice of a MCO.

ERC Endorses CareWorks as Preferred MCO

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ERC is proud to endorse CareWorks as the preferred workers’ compensation Managed Care Organization (MCO) for members.

“CareWorks’ customer service philosophy, effective return to work strategies and quality medical management efforts can provide significant benefits to employers. CareWorks can also deliver substantial medical savings through provider network discounts. These discounts can help employers reduce claim costs and help control future premiums,” comments Pat Perry, President of ERC.

To register for a free event from CareWorks about what your MCO should do for your business, click here.

What is the Difference Between an MCO and a TPA?

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If you are responsible for your workers’ compensation program, it is important to have a fundamental understanding of the roles of a MCO and a Workers’ Compensation Third Party Administrator (TPA). MCOs and TPAs play unique roles in helping employers control workers’ compensation costs.

What is a MCO?

Under Ohio's Health Partnership Program, MCOs are responsible for the medical management of Ohio employers’ work-related injuries and illnesses. Every employer in Ohio must have a MCO, which is paid for directly by the Bureau of Worker's Compensation.

The core MCO functions include:

  • Collecting initial injury reports and transmitting to BWC;
  • Management and authorization of medical treatment to be received by an injured worker;
  • Medical review and bill payment processing;
  • Maintaining a network of BWC-certified healthcare providers;
  • Return to work services;
  • Utilization review;
  • Providing Peer Reviews as necessary for treatment decisions;
  • Processing treatment appeals through the Alternative Dispute Resolution (ADR) process; and
  • Training and education.

Further, MCO associates are medical professionals and their processes are clinically focused. They work diligently to help employers avoid the most costly of claims, i.e. lost time claims – when an injured worker is off work for eight or more consecutive days. With clinicians managing the medical care and transitioning injured workers back to gainful employment, employers are better able to manage their long term insurance premiums.

What is a TPA?

A Third Party Administrator (TPA) assists employers in the administrative and financial aspects of a claim.

The core TPA responsibilities include:

  • Providing risk management consulting to employers;
  • Administering compensation group rating savings programs and other discount program consulting;
  • Pertinent claims investigation;
  • Claims administration;
  • Industrial Commission hearing attendance;
  • Evaluation of claims for workers' compensation coverage; and
  • Assisting employers in the development of workers' compensation cost control strategies.

 

TPA staff typically consists of claim representatives, account representatives, and other workers' compensation professionals. 

ERC is proud to endorse CareWorks as the preferred workers’ compensation Managed Care Organization (MCO) for members. For more information, click here.