The Ohio BWC has contracted with Managed Care Organizations (MCOs) to medically manage work-related injuries and/or diseases. Each MCO follows Treatment Guidelines for determing how the claim should be managed. Health Management Solutions uses Official Disability Guidelines (ODG) for non-chiropractic treatments and Mercy Guidelines for chiropractic treatments.
In addition, each MCO may require prior approval for certain procedures before a treatment or procedure is eligible for reimbursement. Each MCO maintains its own standards for approving treatment and services for injured workers. All requests for services requiring prior approval must be submitted on the BWC form C-9. MCO’s must respond to a C-9 request within 3 days. If additional information is needed for proper consideration, the Provider will be notified within 3 days and the specific information needed will be requested on a BWC form C-9A. The MCO has 5 days to respond after requesting additional information on a C-9A. If not enough information is received, the MCO may deny the treatment request id there is not sufficient information received to support the treatment request in the time of the decision.
If the treatment request is for retroactive authorization, the MCO has 30 days to respond.