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Medical documentation
Providers who treat Ohio's injured workers assume an obligation to submit initial and subsequent reports to the managed care organizations (MCOs) on their behalf. Providers must supply medical documentation to the MCOs at the time of the treatment request.
Providers also assume an obligation to complete all forms required by BWC or the self-insuring employer. Providers may not charge for completing required forms or for submitting necessary documentation.
In some instances, it is necessary for the provider to update the MCO throughout treatment. Such instances include:
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Injured worker does not comply with treatment regiment or misses appointments;
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Negative/lack of response to treatment;
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Changes in outcome or goals of treatment;
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Diagnostic testing results;
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Specialist/consultation results;
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Hospital discharge summaries;
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Emergency room reports, operative reports or other situations that indicate a need to alter a treatment plan/plan of care or concurrently monitor the patient’s care.
In such instances, the provider must submit the update to the MCO within five days of delivery of service or the MCO's request.
When injured workers file a claim for workers’ compensation benefits, they give release to BWC or anyone working for BWC to access information related to their claims. Consequently, submitting medical reports to either BWC or an MCO does not require a release of information signed by the injured worker.
MCOs will not regularly require providers to attach medical documentation to bills for previously approved treatment.
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