New BWC rule seeks more detail in claim reporting | January 16, 2014
When a workplace injury occurs, the initial responsibilities of a managed care organization (MCO) are to collect information on the incident and transmit it to the Ohio Bureau of Workers’ Compensation (BWC) to initiate a new claim. In 2014, BWC is requiring MCOs to pursue additional information before a claim is filed, including the injured employee’s marital status, normal workdays and hours, and the employer’s certification or rejection of the claim.
The CompManagement Health Systems (CHS) triage team has been acquiring the necessary information to file a claim with BWC through the First Report of Injury (FROI) submitted by the physician or the incident report supplied by the employer, and we move quickly to gather the required details. In addition to the exceptional savings and return-to-work results that CHS achieves for clients, we also excel in FROI turnaround time. BWC measures this timing component for all MCOs, and we feel that it is an important part of creating a well-organized claim, promoting timely adjudication, and ensuring your employees receive all of the services and resources needed to recover and return to work.
While the new employee information required by BWC may prompt an additional email or phone call at the outset of a new claim, the clarity we establish in the process can help keep all involved parties focused on what matters most – resolving the injury and getting your employees back to work.
Previously, BWC has asked employers about a claim's certification or rejection through the FROI form or in follow-up communications, and the vast majority of new claims are never contested as the circumstances of the injury are usually clear. Early certification of a claim can speed the process and encourage cooperation from the employee. However, in cases where the claim is questionable, we will be able to submit the injury information to BWC without your certification. You will still have the opportunity to consult with your third party administrator or legal counsel before making that declaration to BWC.
As a part of our efforts to streamline the triage process for you, we can incorporate any specific data elements that will always be the same with each claim, such as physical location of incident or withhold certification/rejection pending further review.
For questions, please contact your Account Executive or reach our customer service team at ClientServices@chsmco.com or 888-247-7799.
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