HELPING TO PUT THE PIECES TOGETHER
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Medical providers, with few exceptions, rendering services in Ohio  must be BWC-certified to participate in the Health Partnership Program (HPP). Certification is based on licensing, certification and accreditation requirements necessary to provide services, as well as other minimum credentials based on provider type.

 

All providers must:

1. Have a current license to practice, as applicable;

2. Meet other general certification requirements for the specific provider type;

3. Possess a current and valid Drug Enforcement Agency (DEA) registration, unless not required by   the provider’s discipline and scope of practice;

4. Have no previous termination from participation in Medicare, Medicaid or the Ohio workers’ compensation system;

5. Have no felony convictions in any jurisdiction, under a federal-controlled substance act or for an act involving dishonesty, fraud or misrepresentation;

6. Provide proof of adequate, current professional malpractice and liability insurance.

 

The Partnership has formed and operates a GOLD CARD PROVIDER NETWORK,™ which is a sub-network of providers who were selected based on verifiable outcomes through data accumulated in the first two (2) years of the (HPP) program and recommendations from the Medical Directors of the RCMCs

The five billing hot spots are:

 

1. Billing for diagnoses that are not allowed in the claim or related to the injury of record;

2. Billing for unauthorized treatment and requesting retro payment;

3. Claim in the 1K program;

4. Statue of limitations or claim settled request for payment; and

5. Statements versus Bills from providers.

 

Each of these requires special handling by the MCO and many times we are at the mercy of the provider making a change to the bill they have submitted. The one that most directly impacts you, the employer, is number five. If an employee brings you a “bill” from a provider, they are most likely bringing you a “statement” which will not contain the necessary information for the MCO to process the bill and may indicate that the provider was not aware that the treatment for workers’ compensation. Please fax those to the billing department so we can do the necessary follow up with the provider.