OhioBWC - Basics: Alternative Dispute Resolution (ADR)
Alternative dispute resolution (ADR)
ADR is the process for resolving medical disputes between the managed care organization
(MCO), BWC, employer, injured worker, their representatives and/or provider without
litigation. ADR affords due process regarding conflicts in medical treatment, but does
not include fee schedule grievances. Providers can initiate a medical dispute
in a workers’ compensation claim. Providers should contact the MCO directly.
They must must initiate their dispute within 14 days after they receive the initial
decision in writing from the MCO. Note: There are two levels of ADR, level 1 completed within the MCO
and level 2 completed at BWC.
ADR can address the following issues:
Quality assurance;
Utilization review;
Determination that a service is or is not covered;
