Report injury

Within 24 hours of the first date of service

Notify MCO of initial treatment by FAX or Phone. Complete First Report of Injury (FROI) and FAX to MCO.

OR

Report injury directly to BWC Online at: www.ohiobwc.com

Submit a treatment plan and Supporting Medical Documentation

Physician´s Report/Treatment Plan for Industrial Injury or Occupational Disease (C-9)

Side I of the C-9 form should be completed at the initial visit and forwarded to MCO within 5 days of Treatment.

Side II should be completed at initial or subsequent visits and forwarded to MCO within 5 days of date of service.

(A new C-9 is not required after each visit; however, a new C-9 must be submitted as the treatment plan changes or every 30 days, whichever is sooner.)

Fax C-9 and supporting medical documentation MCO

Provide Return to Work Status

A return to Work Status should accompany both FROI and C-9. A work status must be submitted whenever an injured worker is unable to return to their original capacity or a change in capacity is made.

(A preprinted form is not required, but is encouraged.)

Fax form to MCO

Request authorization

(Also See Presumptive Approval Guidelines)

Whenever a procedure requiring authorization is needed (before the procedure is performed)

Fax request on the C-9 form to MCO

Earliest: Upon notification of a BWC claim number

Latest: 2 years after the date of service.

Mail, fax, email, or edi on BWC approved mediums:

ADA Form, HCFA 1500, UB-92, C-19