- What is workers' compensation managed care?
- What do I do if I am injured while at work?
- What paperwork needs to be completed?
- What is the difference between a "medical only" and a "lost time" claim?
- Why should I sign an authorization to release medical information?
- Do I have to treat with a specified physician?
- Who pays my benefits and medical bills?
- Do I have to accept transitional work?
- What if I don't like my doctor?
- Should I call my workers' compensation coordinator or CHS about problems?
- What if the doctor you referred me is too far away?
- What do I do if I sustain a work related injury out of state?
- Does CHS pay for physicals and drug screens?
Managed care is the process which ensures that injured workers receive the quality medical care needed to enable them to return to work, or to a functional lifestyle, as quickly and as safely as possible. Your MCO, CompManagement Health Systems, working with providers and your employer, will assist you in providing the most appropriate, cost-effective health care if you sustain a work related injury.
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Immediately report the injury/incident to your supervisor and complete the appropriate paperwork. If for some reason you can not make contact with your supervisor, call CHS at the toll free injury reporting number. CHS will help you begin the claims filing process and direct you to a physician or hospital. In all cases, if you need immediate emergency medical care, go to the nearest medical facility. Your first visit is always covered.
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In cases requiring medical treatment you should complete an internal incident report and the first two sections of the FROI-1 (First Report of Injury form). Be as specific as possible when completing these forms. Failure to complete the internal incident report and FROI-1 will delay processing of your workers' compensation claim. If you are going to be off work completely for 8 or more calendar days, other injury report forms may need to be completed. These forms will be provided by your supervisor.
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A lost time claim occurs when an injured worker is disabled from work for 8 or more calendar days due to an industrial injury. A claim is considered medical only if an injured worker misses 7 or fewer days of work. In either case an accident report and FROI-1 should be completed. In lost time claims a C-84 is an additional form required to be considered for lost time payments of workers' compensation.
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If you do not sign and date an authorization to release medical information, the MCO cannot release medical information to either your employer or your employer's workers' compensation administrator. This may delay payment to you and to all medical providers since diagnostic information must be obtained prior to your claim being allowed for the specific injury which occurred.
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We ask that you seek treatment from an Occupational Health Facility in close proximity to your employer. However, you may seek treatment from any medical provider. If you treat with a provider who is not BWC certified, only your first visit will be paid. You will be responsible for all other payments for services. Remember: you must treat with a BWC certified provider or you are responsible for payment of treatment.
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The BWC makes the final decision regarding payment of compensation and will pay all compensation benefits in accordance with BWC rules and regulations. Concerning medical bills, each provider will bill the MCO directly; the MCO prices and edits the bill and forwards them electronically to the BWC. The BWC completes a wire transfer of funds to the MCO along with the final determination on payment. The MCO then pays the provider. Hopefully this process will be completed in approximately 30 days.
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At CHS we encourage the creation of transitional duty positions. If your company agrees to develop transitional job assignments, the assignments will take into consideration your physical restrictions and a job offer will be made. If you decide not to accept a good faith offer of transitional work, you may be risking the termination of your workers' compensation benefits. The MCO will not be involved in determining your eligibility for lost time payments.
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We ask that you seek medical attention from an Occupational Health Facility in close proximity to your employer. If you are displeased with the treatment you are receiving, you may choose to seek treatment from any provider, however, the provider must be BWC certified to receive payment from CHS. If you are displeased with any services, we encourage you to contact the Workers' Compensation Coordinator or call CHS.
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In order to make the Health Partnership Program a success, we must all work together. Please speak with your supervisor, workers' compensation coordinator, or CompManagement Health Systems' staff when questions and concerns arise. We're committed to working with you to ensure that you have access to the highest quality medical care in your area and that you receive this treatment in a timely and cost-effective manner.
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If you believe the distance required to travel to your provider is unreasonable, see your workers' compensation coordinator for information on other certified providers in your geographic area. We are committed to providing you with quality medical care within your immediate area. We will make every effort to guide you to a Bureau Certified Provider. Should you choose to receive treatment from a non-certified provider, you will be responsible for payment.
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The Ohio Bureau of Workers' Compensation has created an extensive network of certified providers in Ohio. In addition, the BWC has certified a limited number of out-of-state providers. If you sustain an injury while working out of state, the initial treatment is covered, regardless of whether the provider is certified by the Ohio BWC or not. Should you continue to receive treatment out of state, the provider must be BWC certified or you will be responsible for payment. The BWC will continue to certify providers. CHS has the ability to assist providers in the certification process.
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No. Although your employer may require you at the time of your accident or injury to undergo appropriate testing to detect the use or abuse of controlled substances such as alcohol or drugs. You should refer to your employee handbook or contact your Human Resources Department for further information on this topic. These services are not covered for payment under Ohio BWC rules and regulations.
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