MCOs' responsibilities within HPP

MCOs are responsible for:

• Data elements for transmitting the First Report of Injury, Occupational Disease or Death (FROI), the form used to file a claim with BWC;
• Educating injured workers, employers and providers about HPP;
• Communicating with the employer, provider and injured worker on current status and return-to-work planning;
• Using physical capabilities and return-to-work recommendations from providers to facilitate safe return to work for the injured worker;
• Creating timely return-to-work expectations and working with BWC, medical providers and employers to remove barriers;
• Assisting the provider and BWC with requests for additional conditions;
• Overseeing provider management;
• Providing utilization review;
• Managing first level of dispute resolution;
• Determining reimbursement eligibility and paying providers for services.