New BWC Medical Treatment Plan Approval Guidelines

New BWC Medical Treatment Plan Approval Guidelines

Posted: May, 1998

The BWC adopted new medical treatment plan approval guidelines, effective June 1, 1998. The guidelines provide:

  • a treatment plan for non-emergency treatment must be submitted to MCO prior to initiating treatment;
  • use of the C-9 form for presentation of plan is preferred, but another document may be used if it presents at least the same information as the C-9. C-161 Forms will not be sufficient and will be returned with a C-9;
  • an MCO must review and respond to a request within 72 hours or 3 business days. The MCO must respond by fax if possible, if MCO cannot respond by fax it must call physician and follow up in writing;
  • If the MCO needs more information or a medical review, the MCO has 5 days to make a decision from receipt of additional information. If medical review results in decision to alter the plan, such decision must be made within the 5 days;
  • the treatment plan is considered approved if
    1. the MCO does not timely communicate its decision to the physician, AND
    2. the treatment plan was completely and correctly documented on an appropriate document, AND
    3. there is proof of submission to the MCO, AND
    4. the treatment is for the allowed condition(s), AND
    5. the claim is payable
  • the MCO must send copy of treatment plan, including the MCO’s decision, to the BWC for inclusion in the claim file.
Information courtesy of the Ohio Workers’ Compensation Bulletin. Subscribe to the Ohio Workers’ Compensation Bulletin to keep informed about the Ohio workers’ compensation system.