MCO open enrollment ongoing through May

It happens every other year as the weather gets warmer and the summer months approach. But it doesn’t have anything to do with April showers or May flowers — it’s the Ohio Bureau of Workers’ Compensation’s MCO open-enrollment period. This is the biennial time in which employers can choose to change their managed care organization, and this year, it takes place from May 2-27.

You may have seen this period come and go in previous years without taking action or even understanding what it means.

If you are satisfied with your current MCO, you do not need to take any action to continue your relationship, says Barbara Jacobs, director of the MCO Business and Reporting Unit of the Ohio BWC.

Time to consider options

If, however, you would like to switch, are on the fence or aren’t sure, now is the time to evaluate other options. You don’t need to provide a reason for changing MCOs, as selection is entirely an employer’s decision.

MCOs perform important duties in the unfortunate event that a worker is injured on the job.

They are responsible for reporting claims, providing a diverse panel of certified health care providers, managing medical cases (including reviewing treatment requests and making treatment reimbursement decisions), resolving disputes, reviewing and paying bills, and educating and assisting employers regarding safety and return-to-work initiatives.

Selecting an MCO is an important decision as it directly affects the health and safety of your company’s employees and your bottom line.

“MCOs work closely with the BWC to provide comprehensive claims management, medical management and utilization review services to ensure injured workers receive the timely, quality medical care they deserve,” Jacobs says. “A timely and effective response following a workplace injury is critical to facilitating a quick and safe return to work. This is one of the most influential factors in the overall cost of a claim because the longer someone is in the system, the greater the cost.”

All state-funded businesses — those who pay workers’ compensation premiums into the state insurance fund, i.e., not self-insured employers — are required to have an MCO. The Ohio BWC pays MCOs from a portion of the premiums that Ohio employers pay.

New businesses must choose an MCO within 30 days of receiving the Ohio BWC’s new employer kit. If the new employer does not choose by then, the Ohio BWC will assign an MCO to it.

Individual needs are important

There are a number of factors to consider when selecting an MCO.

“Because different factors may be important to different businesses, we encourage employers to carefully evaluate what their individual needs are because they may vary,” Jacobs says.

For example, some companies might be more comfortable with a smaller MCO that handles fewer employers and claims, while some might prefer a larger MCO that handles a larger number of employers and claims.

Employers can evaluate MCO data by viewing the Ohio BWC’s MCO Report Card at http://bit.ly/HhVEdM. Data includes number of employers, number of claims, first report of injury timing, first report of injury turnaround time and Quality Medical Management for each MCO. The Ohio BWC calculates the scores based on the information it receives regularly from the MCOs.

Although open enrollment happens every two years, it updates the information yearly. The BWC also publishes an MCO Selection Guide available at http://bit.ly/HdlJgO. It includes an alphabetical listing of Ohio MCOs and their five-digit identification codes.

If you have additional questions, the Ohio BWC recommends contacting MCOs directly. It’s a good idea to ask about an MCO’s experience: Does it work with similar businesses in your industry?

Choosing an MCO

Selecting an MCO that has managed similar claims will expedite your claims process — returning your injured employee to work sooner and helping you avoid costs associated with lost productivity. Also, ask whether you will be assigned a case manager and how often you will receive information from this person. You want to keep communication with your MCO open to ensure you and your employees are receiving the best service and seeing the best results.

In addition, Jacobs says to ask the MCO if it has negotiated payments less than the Ohio BWC’s fee schedules, resulting in additional savings. For example, some MCOs offer discounts for using providers within their network.

You will most likely begin receiving marketing materials, phone calls and possibly even visits from area MCOs as open enrollment is the only time they are allowed to market themselves to your company. The Ohio BWC reminds employers to keep in mind that these interactions are created with the intent to influence your MCO selection.

Jacobs says that an MCO cannot decline a specific employer. If an MCO has placed itself “at capacity” for a specific county, however, no employer within that county will be able to select that MCO. Also, there is a possibility that an employer’s MCO selection may be rejected.

“The Ohio BWC may place an MCO at capacity because it is not in compliance with BWC requirements or is waiting on a pending merger or decertification,” she says. “If the employer’s selection is rejected, they can either make another selection or contact the MCO to discuss the matter.”

FOR MORE INFORMATION on MCO open enrollment, contact the Ohio Bureau of Workers’ Compensation at (800) 644-6292 or visit www.bwc.ohio.gov