|
MCO
Decision Process
When there is a medical dispute, the
following decision making process is supposed to be followed:
| 21
days |
The MCO has 21 days to make a
decision. MCO's medical dispute resolution process includes review by
an individual or individuals licensed pursuant to the same section of
the Revised Code as the health care provider.
From the time the MCO recieves notice of a medical
dispute, the dispute process must be completed in 21 days. [see O.A.C.
4123-6-16]
|
| 7
days |
If the provider, injured worker, or
employer is not satisfied with the MCO decision, they can appeal to the
BWC. Any appeal must be filed within 7 days of the MCO decision. |
|
7 days
|
The MCO must refer the dispute to the BWC within
7 days of receipt of the request for BWC review of a disputed medical
issue. |
| 14
days |
The BWC has 14 days to decide the
dispute. The BWC will issue a "tentative order" announcing that
decision. |
| 14
days |
The BWC tentative order may be
appealed to the IC. An appeal must be filed within 14 days of the
tentative order. Only the injured worker or employer may appeal to the
IC -- neither the provider nor the MCO can appeal to the IC. If the
tentative order is not appealed, it becomes a final order. |
NOTE: If a party files a
motion raising other questions, this will cause the BWC to send the
file to the IC for hearnig, thus taking it out of the MCO dispute
resolution process.
|
