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OhioBWC - Provider: Managed Care Comes to Ohio For Employer
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Managed Care Comes to Ohio
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| For employers |
State-fund employers should keep the following things in mind:
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- Competition between managed-care organizations (MCOs) should drive up the quality of health care while containing cost;
- HPP focuses on providing quality care with the purpose of safely returning injured workers to the job;
- HPP will eventually reduce overall health-care costs to treat injured workers;
- You have a choice of MCOs;
- As a new employer you must select an MCO to medically manage your employees' claims or BWC will assign one to you;
- You will have an opportunity to change your MCO once every year. BWC will notify you once employer enrollment starts with a list of BWC-certified MCOs in your county of operation. If you have sites in more than one county, you may choose a different MCO per county if you wish.
- All medical management will be handled by the MCO regardless of your employees' choice of providers and those providers' panel affiliation;
- HPP provides a dispute resolution process.
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The third and final phase of HPP implementation is upon us. On Dec. 15, MCOs will begin medically managing phase three claims. Phase three claims are those with dates of injury before Oct. 20, 1993. If any of your employees have phase three claims, you should receive a reminder post card in early December.
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HPP is designed to benefit both you and your employees. And working together we can make HPP an effective managed-care system. So, we've included some steps you can take to make HPP work for your company.
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One of the key steps to make HPP work is the early reporting of an injury. By rule health-care providers must report an injured worker's injury to the appropriate MCO within 24 hours or one business day of the initial treatment or initial visit.
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This 24-hour reporting is a legal and contractual requirement. Non-compliance could result in loss of BWC-certification, removal from an MCO's panel or both for the health-care provider. So, if your injured employee sought treatment without informing you of the injury, the claim may already be filed.
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Self-insuring employers should know the following about the Qualified Health Plan (QHP):
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- QHP will improve the quality and medical management of health care;
- QHP provides a dispute resolution process;
- The plan requires the first notification of injury within 24 hours, which provides early intervention and lowers costs;
- Participation in QHP is voluntary for current self-insuring employers and mandatory for new self-insuring employers;
- With QHP, you will create or contract a QHP panel to provide medical services for your company's employees. Submit this QHP for certification by BWC;
- Once the QHP is certified, you and the QHP must educate your employees about the QHP panel and how they should seek services if injured;
- QHP will be responsible for medical management of all workers' compensation claims submitted by company employees;
- You are financially responsible for all services related to the QHP;
- To sign up for QHP, you must attend a BWC training session where you will receive details of the QHP design and application process. To sign up for a session call 1-800-OHIOBWC and follow the options.
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