On the opposite of this page is a customer

service survey designed specifically for providers.

Your opinion matters. Please take a few minutes

today to complete this survey and submit it to

the toll-free fax number, (866) 263-5601, by

May 1, 2005. This information and follow-up

contacts will help us to improve the Health

Partnership Program.

Your opinion mattersProvider survey

Content• MCO notes• Revenue codes 270-279• Medical documentation• 2005 Provider Fee Schedule available online• Failure to comply with prior authorization policies and procedures • Vertebral axial decompression • MCO update • Provider survey

BWC contactsCall BWC at 1-800-OHIOBWC and follow the prompts, or logon to ohiobwc.com and select either Medical providers orOhio employers. You also can contact BWC via mail at:

Ohio Bureau of Workers’ Compensation30 W. Spring St., 20th FloorColumbus, OH 43215-2256

MCO notesAuthorized providers and external parties gained access to view MCO notes on Jan. 18, 2005. In addition to claim notes, authorized providers can view managed care organizations’ (MCOs’) notes in the Notes info service offering on ohiobwc.com.

BWC added a note category section to the Notes info service offering to show whether BWC or an MCO wrote the notes. Displaying MCO notes allows BWC and MCO customer-care team members to view BWC’s and MCOs’ progress, and provides better service for customers.

Information documented on MCO notes includes:• Claim progress; • Recommended next steps for claim management; • Barriers to managing the claim/injured worker recovery.

Revenue codes 270-279 BWC eliminated the requirement for MCOs to review vendor invoices for UB-92 bills with revenue codes 270-279 totaling $10,000 or more, for bills received by the MCO on or after Jan. 1, 2005. Bills originally received by the MCO when the policy was in effect (Oct. 1, 2003, to Dec. 31, 2004) are still subject to review of vendor invoice information prior to payment. On a related note, MCOs previously were required to review paid inpatient hospital bills with an allowed amount totaling $10,000 or more; however, for 835s (EDI transaction or remittance advice from BWC) received by the MCO on or after Jan. 1, 2005, reviews are required only on bills with the allowed amount totaling $20,000 or more. Reviews are to be completed within 60 calendar days of BWC’s paid date.

Medical documentationProviders undertaking an injured worker’s treatment are required to submit initial and subsequent reports to BWC and the MCO. By law, filing a workers’ compensation claim authorizes BWC and MCOs to receive medical documents to use to investigate and determine the claim. Timely submission of medical documentation minimizes the possibility claim authorizations (e.g., treatment authorizations, medical bill payment, etc.) will be delayed.

MCOs are required to maintain an integrated case management and bill payment system so they should not regularly require providers to attach medical documentation to bills for previously approved treatment. However, providers will need to submit medical documentation to the MCO if services billed do not correspond to approved treatment or if the MCO needs information to show what services were provided.

Submitting medical documentation to BWC or an MCO through the use of an electronic or paper template is acceptable as long as documentation submitted is specific in describing the provided service. To reduce the number of duplicate requests for medical documentation, make sure it is indexed and available in BWC’s Medical Repository system. Please use the MCOs’ toll-free fax numbers listed in the MCO update section of this publication or the MCO Directory on ohiobwc.com.

Failure to comply with prior authorization policies and procedures Effective April 1, 2005, BWC will require MCOs to notify physicians who fail to comply with prior authorization policies and procedures as outlined in BWC’s Billing and Reimbursement Manual. Per Ohio Administrative Code 4123-6-02.3 (D)(6), BWC-certified providers have agreed to “practice in a managed care environment and adhere to MCO and bureau administrative procedures, and procedures concerning provider outcome measurement data, peer review, quality assurance, utilization review, billing procedures and dispute resolution, subject to rule 4123-6-16 of the Administrative Code.” Failure to do so can negate the MCO’s ability to work with the physician to effectively manage the injured worker’s claim.

Providers will receive a letter from the MCO each time a Physician’s Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) is received after the treatment or service has been provided.

Providers also will receive a letter from the MCO each time medical documentation, including the Physician’s Report of WORK ABILITY (MEDCO-14), Request for Additional Medical Documentation for C-9 (C-9-A) or other documentation necessary to manage an injured worker’s claim is requested but not received in the time period identified in the Billing and Reimbursement Manual.

Ongoing failure to adhere to MCO and BWC administrative procedures by submitting C-9 requests retroactively or by not responding timely to requests for medical documentation may result in reduction in reimbursement and/or decertification.

2005 Provider Fee Schedule available onlineFor your convenience, BWC’s 2005 Provider Fee Schedule is now available online. To download the fee schedule, log on to ohiobwc.com, click Medical providers and then Forms.

BWC has adjusted reimbursement levels for a number of HCPCS Level II codes reported in the hardcopy booklet and electronic version of the fee schedule on CD. Please note E0221, infrared heating pad, is not covered ($0.00). This unit delivers infrared therapy, which is reimbursed by BWC as a covered physical therapy modality. BWC does not typically reimburse equipment that delivers a physical therapy modality for in-home patient use since professional supervision is necessary in most situations, and it is generally not a reasonable cost. The replacement pads A4639 also are not covered.

We have updated our interactive and downloadable versions of the online fee schedule to reflect these changes.

Level II Reported in Corrected HCPCS fee schedule 2005 feeA4245 $.04 BRA4247 $.29 BRA4250 $.20 BRA4349 BR $1.04A4605 BR $16.40A4608 $10.00 $58.15A5500 BR $59.36A5501 BR $178.04A5503 BR $26.40A5504 BR $26.40A5505 BR $26.40A5506 BR $26.40A5507 BR $26.40A7045 BR $19.47A7527 BR $3.58E0221 $2113.46 $0.00E0627 $363.00 $363.00E0720 $233.10 $199.80E0730 $233.10 $199.80E0735 $45.00 $42.75E0740 BR $52.00E0745 $266.40 $233.10E0849 BR $515.00E1039 BR $227.00E1841 BR $453.00E2205 BR $33.00E2206 BR $41.00E2368 BR $516.00E2369 BR $450.00E2370 BR $803.00E2601 BR $89.00E2602 BR $162.00E2603 BR $223.00E2604 BR $316.00E2605 BR $322.00E2606 BR $436.00E2607 BR $296.00E2608 BR $354.00

Level II Reported in Corrected HCPCS fee schedule 2005 feeE2611 BR $312.00E2612 BR $423.00E2613 BR $393.00E2614 BR $544.00E2615 BR $452.00E2616 BR $609.00E2619 BR $51.00E2620 BR $575.00E2621 BR $548.00J7621 BR Deleted K0628 BR $24.00K0629 BR $36.00K0630 BR $69.00K0631 BR $215.00K0634 BR $44.00K0635 BR $63.00K0636 BR $331.00K0637 BR $68.00K0639 BR $131.00K0640 BR $231.00K0642 BR $826.00K0644 BR $804.00K0645 BR $1,091.00K0646 BR $1,043.00K0647 BR $1,062.00K0648 BR $1,043.00K0649 BR $842.00L0430 Not reported $1,227.00L1932 BR $715.00L2005 BR $2,898.00L3911 BR $18.00L5782 BR $3,402.00L5856 BR $19,364.00L5857 BR $6,871.00L8511 BR $59.00L8512 BR $1.76L8513 BR $4.19L8514 BR $76.00L8515 BR $51.00

MCO updatePlease make sure your medical documentation is indexed in BWC’s medical repository system by using the MCO’s toll-free fax numbers listed in the tables on the next page. Case management contacts and phone numbers for each MCO also are included. The complete, updated MCO Directory is available on ohiobwc.com.

Vertebral axial decompression BWC requires spinal decompression, decompression therapy (vertebral axial decompression) to be billed with the CPT code for mechanical traction and will pay one unit of service per visit, regardless of the length of time traction is applied. The decision regarding authorization of decompression therapy will remain with the individual MCO. Refer to chapter 3 of the Billing and Reimbursement Manual on ohiobwc.com for policy details.

1. Circle what best describes your provider type:• MD, DO, or DC• Hospital• Ancillary provider (PT, OT, etc.)• Rehab provider• Other (please indicate your provider type)

2. Circle what best describes your role:• Physician (MD, DO, DC, etc.)• Other provider (PT, OT, radiology tech)• Office manager/billing supervisor• Billing staff• Other (please indicate your role)

NOTE: This survey is to measure satisfaction with state-fund claims falling under the Health Partnership Program and NOT for self-insured claims.

3. When filing a First Report of Injury, Occupational Disease or Death (FROI), do you file:

• Online at ohiobwc.com• Fax• Mail• Phone• My office does not file FROIs (skip to question 6)

4. Please rate your satisfaction with the FROI process:• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

5. When seeking information, such as claim status or diagnosis (ICD code) allowances, how do you prefer to obtain the information? Circle those methods that you use most frequently.

• BWC Web site – ohiobwc.com• 1-800-OHIOBWC – automated information• 1-800-OHIOBWC – speaking to a representative• Written notification

BWC services and policies

Overall, how do you rate your satisfaction with the following BWC services and policies?

6. BWC’s Web site• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

7. Provider relations – 1-800-OHIOBWC option 3, 0 only• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

8. Provider enrollment and certification• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

9. Provider fee schedule• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

10. Provider education and training• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

MCOs and servicesOverall, how do you rate your satisfaction with the following managed care organization (MCO) services?

11. Your ability to get quick and accurate answers?• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

12. Your ability to reach an employee of the MCO?• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

13. Timeliness in processing authorization requests?• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

14. Timeliness in processing bills?• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

15. Timeliness in facilitating bill adjustments?• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

16. The MCOs’ overall communication with you about the medical management of the case?

• Very satisfied• Satisfied• Neutral• Unsatisfied• Very unsatisfied

17. If you could change one thing about workers’ compensation processes or policies to make your job easier, what would it be (attach additional pages if needed)?

18. What are the biggest barriers with returning injured workers to work and assisting with meeting optimal return-to-work measurements (attach additional pages if needed)?

May we follow up with you to discuss your responses in order to improve processes?

Name

Phone

E-mail

BWC Provider Survey BWC is conducting a provider survey to determine your satisfaction with workers’ compensation processes. In an attempt to improve processes and services for providers, BWC intends to utilize survey results to identify areas needing additional attention. You may fax your responses to (866) 263-5601.

Thank you for your response.