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MCO/TPA/BWC Functions
Managed Care Organization Functions (MCO)
Ohio BWC requires that every employer has an MCO to medically manage claims. There is no additional cost to employers as MCO’s are paid through a portion of your BWC premiums.
MCO Functions include:
The MCO does not determine claim/diagnosis allowances, denials or appeals of those decisions. This includes additional allowance requests.
This is not an all inclusive list of the services provided by the BWC, your MCO, or your TPA. We hope it will help you gain a better understanding of the Ohio Workers’ Compensation Model.
Third Party Administrator Functions (TPA)
The BWC does not require the employer to retain a TPA. Employers may enter into a private contract with a TPA of their choice.
TPA Functions include:
This is not an all inclusive list of the services provided by the BWC, your MCO, or your TPA. We hope it will help you gain a better understanding of the Ohio Workers’ Compensation Model.
Bureau of Workers’ Compensation Functions (BWC)
The Ohio BWC is the actual insurance company for work related injuries.
BWC Functions include:
Managed Care Organization Functions (MCO)
Ohio BWC requires that every employer has an MCO to medically manage claims. There is no additional cost to employers as MCO’s are paid through a portion of your BWC premiums.
MCO Functions include:
- Process First Report Of Injury (FROI)
- Medically manages the injured worker’s claim
- Review and process requests for medical treatment
- Facilitate timely return to work
- Review and process medical bills
- Process 1st appeal of treatment decisions through Alternative Dispute Resolution (ADR)
- Communications with the employer, provider and injured work
- Provide safety and educational services when requested
- Provide quarterly and customized reports when requested
The MCO does not determine claim/diagnosis allowances, denials or appeals of those decisions. This includes additional allowance requests.
This is not an all inclusive list of the services provided by the BWC, your MCO, or your TPA. We hope it will help you gain a better understanding of the Ohio Workers’ Compensation Model.
Third Party Administrator Functions (TPA)
The BWC does not require the employer to retain a TPA. Employers may enter into a private contract with a TPA of their choice.
TPA Functions include:
- Provide group rating services
- Review first reports of injury as the employee representative
- Manage overall claims for employer
- Facilitate timely return-to-work
- Process motions, appeals and orders
- Represent employer at hearings
- Pursue handicap reimbursement and settlements
- Initiate independent medical and BWC exam
- Consult on alternative savings programs
- Serve as employer’s advocate
- Provide education
This is not an all inclusive list of the services provided by the BWC, your MCO, or your TPA. We hope it will help you gain a better understanding of the Ohio Workers’ Compensation Model.
Bureau of Workers’ Compensation Functions (BWC)
The Ohio BWC is the actual insurance company for work related injuries.
BWC Functions include:
- Provide initial accident investigation for claim allowance
- Make decisions regarding claim/diagnosis allowances or denials
- Make decisions regarding additional allowance requests
- Develop policies to implement Voc Rehab service delivery
- Issue benefit payments—wage/disability compensation
- Process Permanent Partial Disability applications and schedule applicable exam
- Schedule Extent of Disability exams
- Provide safety and education services
- Provide extensive reporting
- Determine premium amount
- Provide discount programs
- Refer hearing issues to the Industrial Commission
- Assist with bringing the claim to resolution
