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Injury Reporting & First Fill Prescription Benefits

Posted: March 19, 2014

Proper steps to follow when a new workplace injury/accident occurs.

  1. Injured workers should immediately notify their employer of their injury/accident and obtain a CareWorks Managed Care Organization (MCO) Identification Card or a CareWorks Injury Reporting Packet.
  2. Seek treatment from a CareWorks network or BWC-certified provider. In emergency situations, injured workers should immediately notify their employer and seek treatment at the nearest medical facility (or call 911 or a local emergency number).
  3. Ensure injured worker has appropriate transportation to receive initial medical care.
  4. Complete the BWC First Report of Injury (FROI) form with the injured employee as fully as possible and submit to CareWorks as quickly as possible, using one of four reporting options:
    • Fax completed FROIs to CareWorks, toll-free, at 1-888-711-9284;
    • Report telephonically by calling CareWorks, toll-free, at 1-888-627-7586;
    • Email FROIs to cwfroi@careworks.com; or,
    • Visit www.careworksmco.com and click on the Injury Reporting Center under Tools and Resources.
  5. Injured workers should complete any internal injury reporting forms so their employer can track workplace injuries.
  6. To ensure payment on compensable claims, all care after the initial treatment needs to be provided by a CareWorks network or BWC-certified provider.

Your CareWorks Account Executive would be pleased to develop personalized Injury Reporting Packets to further promote timely and accurate injury reporting.

BWC’s First Fill Prescription Benefits

Immediately following an injury, when an employee may be at the peak of their pain and discomfort, BWC ensures they will receive appropriate prescription benefits without paying any out-of-pocket expenses for their needed medication.

For the last several years, BWC has encouraged pharmacies to accept claims “on assignment.” This means the pharmacy will fill the needed medication for the injured worker without a claim number and at no charge to the injured worker. Once the claim becomes allowed, BWC’s pharmacy benefit manager (PBM) will pay the pharmacy.

In situations such as this, the pharmacy does get an additional dispensing fee for their flexibility. This program is not limited to one pharmacy. Any pharmacy, from a large national chain to a small local pharmacy, can agree to this process.

In some cases, the pharmacy will not agree to take a claim on assignment. Rather, they will charge the injured worker the amount the PBM would pay for the prescription. In these instances, as long as the pharmacy files the information with the PBM, the injured worker will be reimbursed by the pharmacy once the claim is allowed. If the claim is disallowed, the cost of the prescription will become the responsibility of the injured worker.

This program is designed to alleviate any concerns an injured worker may have about pharmacy benefits so they can focus on recovering from their injury and successfully returning to work.

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