Frequently Asked Questions About Ohio Workers' Compensation
Below are answers to some often asked questions we receive from CareWorks customers.
What is the difference between a Managed Care Organization (MCO) and a Third Party Administrator (TPA)? CareWorks is your company’s selected MCO and is responsible for the medical management of your workplace injury claims and helping facilitate a safe and successful return to work for your injured employees. All Ohio employers are required by BWC to select an MCO. There are no direct fees for our services as they are included with the premium you pay to BWC.
A TPA is optional in Ohio and acts as an advocate to employers by providing risk management services focused on maintaining or reducing an employer’s workers’ compensation costs. If an employer is eligible, a TPA can offer programs to help lower the employer’s BWC premium obligation. TPAs also attend Industrial Commission hearings on behalf of their clients. TPAs do charge a fee for their services.
Why is it important to fill out the BWC First Report of Injury (FROI) form completely?
BWC relies on MCOs to gather complete and accurate information for all new Ohio workplace injury claims. In addition to obtaining medical documentation, MCOs are required to gather injured worker and employer demographic information and specific injury data. When any of these elements are missing from a new injury report, CareWorks is required to make follow up phone calls to employers, injured workers and providers to gather the needed information prior to electronically submitting a claim to BWC.
A complete FROI form can:
- Produce more accurate claim information;
- Expedite the processing of a claim by allowing for a quicker turnaround time and faster medical management; and,
- Eliminate the need for additional follow up calls.
CareWorks offers four options for reporting a new workplace injury:
- Fax a completed FROI form toll-free to 1-888-711-9284;
- Report an injury telephonically by calling us toll-free at 1-888-627-7586;
- Email a completed FROI form to firstname.lastname@example.org; or,
- Visit www.careworksmco.com and complete your injury report online using our Injury Reporting Center in the Tools and Resources section.
Who pays for drug screens?
The employer is responsible for paying for post-injury drug screens. If your company currently requires post-accident drug screens, or you are thinking about starting a program, contact your CareWorks Account Executive to learn more about BWC’s Drug-Free Safety Program.
Who pays for Injured Worker Prescriptions?
OptumRx is BWC's Pharmacy Benefits Manager and is the sole processor of drug bills for Ohio state-fund, black lung and Marine Industrial Fund claims. OptumRx can assist pharmacies with questions about bill submission and prescribers with questions about requests for prior authorization. To contact OptumRx, call 1-800-644-6292 and follow the prompts. Once a claim is allowed, BWC-certified pharmacies bill OptumRx directly, requiring no out-of-pocket expense to the injured worker. Further, BWC encourages pharmacies to accept claims “on assignment.” In these cases, the pharmacy fills needed medications without a claim number and at no charge to the injured worker. Once the claim becomes allowed, OptumRx pays the pharmacy.
In cases where a pharmacy does not agree to take a claim on assignment, an injured worker may get charged the amount the PBM would pay for the prescription. However, as long as the pharmacy files 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.
Why should you bring someone back to work as soon as possible?
Bringing an injured worker back to work in some capacity after an injury is a positive for everyone involved with the claim. It allows the injured worker to return to a normal routine and minimizes lost productivity for the employer. Ideally, the injury is minor and the injured worker returns to their full job function immediately. However, for situations when the injured worker cannot perform their normal job tasks, it is beneficial to have clear and specific job descriptions for both full duty and alternative duty positions. This helps provide a starting point for obtaining restrictions and a framework for providers to focus on what the injured worker can do versus what they cannot do.
Additionally, you may qualify for BWC’s Transitional Work Bonus program. This program provides a rebate to eligible employers who bring injured workers back to work within restrictions. BWC also has a Transitional Work Grant program available to assist employers with creating a formalized transitional work program including compiling functional job analyses. Please contact your CareWorks Account Executive if you would like to learn more about the positive impact transitional work can have on your claims.
Are you utilizing CareWorks customized reporting?
CareWorks has the ability to produce reports on most of the data elements we collect in our system. Some of this information is already documented in our quarterly reports. Some examples of the data we can provide employers include:
- Injured worker name;
- Date of injury;
- Physician of record;
- Employer/location name;
- Filing date;
- Claim status;
- Claim type (medical only/lost time);
- Accident description;
- Diagnosis codes assigned to the claim and their status; and,
- Return to work information (last day worked, modified duty return to work date or full duty return to work date).
Your individually assigned CareWorks Account Executive is a capable of generating any of these reports.
What should I do if I receive an injured worker bill?
When accepting a workers’ compensation patient, BWC-certified providers agree not to bill injured workers and accept payment at BWC’s fee schedule. If a bill is sent to an injured worker or an employer in error, the bill should be forwarded to CareWorks.
- Email to CareWorks at email@example.com
- Fax to CareWorks at (614) 789-6099
- Mail to CareWorks at P.O. Box 182726 Columbus, Ohio 43218-2726.
Does CareWorks offer online access to claims information?
Yes, CareWorks Claims Portal currently provides on-line claims management information our employer customers can access via the Internet. Our portal provides employers with the following information:
- Employer information;
- Injured worker demographics;
- Physician of record;
- Medical bill payment history;
- Accident descriptions;
- ICD codes with status in claim;
- Return to work status;
- Glossary of terms;
- Ability to run basic reports;
- Imaged documents;
- Managed care specialist/nurse assignment; and
- Case notes.
To gain Claim Portal access, an employer is assigned a user name and password. The username will be the individual’s e-mail address and the initial password will be randomly generated. Users have access to the policy number(s) assigned to their location. Users must have a web browser with 128-bit encryption to ensure a secure connection.
We hope the answers we provided help you better understand how the claims management process works for Ohio workers’ compensation claims. Please call or email CareWorks if you ever need help with a workplace injury. We consistently strive to exceed customer expectations and make a difference in the lives we touch.