Frequently Asked Questions and Answers
How can I get in touch with University Hospitals CompCare?
Call 1-800-818-7273 for customer service, whether you are an existing customer or are simply interested in learning more about us. This Web site is also updated often with University Hospitals CompCare news, as well as information and data for employers, employees and medical providers.
What specifically is the role of an Ohio workers' compensation MCO such as University Hospitals CompCare?
University Hospitals CompCare is a workers' compensation managed care organization (MCO) certified statewide by the Ohio Bureau of Workers' Compensation (BWC) to manage the care of injured workers and speed their recovery and return-to-work.
Specific MCO responsibilities include:
- Filing first reports of injury with the state and completing other administrative and customer service tasks.
- Facilitating communications among, and gathering information from, the employer, injured worker and medical provider.
- Providing case management that facilitates early treatment, rehabilitation and return-to-work.
- Responding to providers' requests to perform medical procedures.
- Ensuring timely and accurate payment to medical providers for MCO-authorized care rendered to BWC-allowed claims.
What sets University Hospitals CompCare apart from all other workers' compensation MCOs in the state?
Cleveland-based University Hospitals CompCare stands out as a stable, high-quality, compassionate and locally based MCO. University Hospitals CompCare is an affiliate of University Hospitals Health System (UHHS), Ohio's premier health care delivery system, and is one of the few workers' compensation MCOs with a legacy of local health care excellence. In fact, UHHS has more than 20 years of experience with managed care products and more than 50 years of experience in occupational medicine, including the development of "best practices" for the treatment of occupational injuries.
By working as a team internally and partnering with employers, employees and medical providers externally, University Hospitals CompCare is able to bring compassion and efficiency to the medical management and return-to-work processes.
How can a company select University Hospitals CompCare to be its MCO?
Since 1997, every state-fund (non-self-insured) company in Ohio - whether it is privately owned or in the public sector - has been required to have a workers' compensation managed care organization (MCO) for the medical management of workplace injuries and illnesses. Designating an MCO is one of the first things that a new employer or an employer new to Ohio must do.
Every two years, the Ohio Bureau of Workers' Compensation (BWC) sponsors an open enrollment period during which employers can choose a different MCO if they wish.
In the meantime, some employers have been able to switch to University Hospitals CompCare if their MCO goes out of business or is sold to another MCO. This has happened more than a dozen times in the last three years. The "shakeouts" are not surprising in an emerging market such as workers' compensation managed care, but they do point out the benefits of selecting an MCO such as University Hospitals CompCare, which has a legacy of health care excellence and deep roots in Ohio.
Occasionally, employers are allowed to switch MCOs if they are dissatisfied with their current situation, although BWC prefers that employers use the open enrollment process to make their decision.
How diverse are University Hospitals CompCare's industry expertise and geographical reach?
University Hospitals CompCare's customer base includes employers from all over the state, in businesses ranging from manufacturing to municipalities, construction to professional service firms. University Hospitals CompCare serves both state-fund employers, who are required to select a managed care organization; and self-insured employers, who have the option to develop a qualified health plan with the help of an organization such as University Hospitals CompCare.
University Hospitals CompCare is based in Cleveland and provides statewide service. University Hospitals CompCare's medical provider network meets the Ohio Bureau of Workers' Compensation's credentialing criteria and includes access to providers in all 88 Ohio counties and contiguous states.
How much expertise does University Hospitals CompCare have in workers' compensation?
University Hospitals CompCare began offering managed care services in 1997, which means we have been part of Ohio's Health Partnership Program (HPP) since its inception. Unlike many other MCOs, which have legal or insurance roots, University Hospitals CompCare grew out of a health care organization, University Hospitals Health System (UHHS). UHHS has more than 20 years of experience with managed care products and more than 50 years of experience in occupational medicine, including the development of "best practices" for the treatment of occupational injuries.
While some Ohio workers' compensation MCOs have dropped out of HPP since 1997, University Hospitals CompCare has raised its profile and service levels within the state. We have continuously improved and so has BWC's oversight of the MCO program.
Several national studies and organizations have identified the Ohio MCO program as a national model for controlling costs and providing medical management that emphasizes return to work. For more information, see the article "National Study Gives Ohio High Marks."
What can University Hospitals CompCare do for self-insured employers?
University Hospitals CompCare helps self-insured employers establish qualified health plans (QHPs) to improve the quality and efficiency of medical management for work-related injuries and illnesses. Much like our MCO program, our approach to QHP involves assigning a customer service representative, nurse case manager and provider relations staff member to each employer. We process the claims, administer the medical management and return-to-work programs, and coordinate our efforts with medical providers and the employer or its representative on claim allowance issues to ensure a smooth process.
Establishing a QHP is optional for current self-insured employers but mandatory for newly self-insured employers. Because self-insured employers do not pay into the state fund in the same manner as state-fund employers, the self-insured are financially responsible for all services related to the QHP.
The Ohio Bureau of Workers' Compensation has many specific criteria for the QHP design and application process. For more information, contact BWC at 1-800-OHIOBWC (644-6292).
Who is in University Hospitals CompCare's medical provider network?
Our network consists of more than 3,500 health care providers, including 2,000 primary care physicians, as well as chiropractors, physical therapists, podiatrists and hospitals. As an affiliate of University Hospitals Health System, University Hospitals CompCare has devised its network to include leading providers in the state and represent virtually every discipline and specialty. As a result, injured workers often choose to seek care from within the University Hospitals CompCare network, although they certainly have the option to select other BWC-certified providers that are outside the network. All total, there are some 100,000 state-certified providers, and University Hospitals CompCare welcomes the opportunity to work with any and all of them in a concerted effort to facilitate treatment, rehabilitation and return to work. Click to find a provider in your area.
Who has the authority to choose the medical provider for an injured employee?
Employees can choose any provider they wish for an initial visit, if it is an emergency. After that, employees may see any provider among the more than 100,000 certified by the Ohio Bureau of Workers' Compensation (BWC). The employer or MCO can encourage, but not require, the injured worker to see a provider who is part of the MCO's panel (all of whom must be BWC-certified).
University Hospitals CompCare's provider panel includes more than 3,500 physicians, chiropractors, physical therapists and podiatrists, and about 100 acute/general care and rehabilitation hospitals. Panel providers allow MCOs such as University Hospitals CompCare to ensure continuity, high quality of care and cost effectiveness. However, workers retain the ultimate right to choose.
There are no co-payments or deductibles for workers who seek treatment for injuries related to approved claims as long as they see a BWC-certified provider. Workers who visit uncertified providers may be responsible for some or all of those costs.
What is University Hospitals CompCare's administrative process for employers and employees once an injury occurs?
The process can be summarized as follows:
Employees must:
- Notify their supervisor (their employer) that an injury has occurred.
- Seek treatment from a BWC-certified medical provider, preferably one who is also a University Hospitals CompCare network provider.
Employers must:
University Hospitals CompCare will:
- File the First Report of Injury electronically with BWC.
- Manage the administrative end of the claim through a client-specific customer service representative.
- Coordinate medical care through its case managers, all of whom are registered nurses experienced in the medical management of workplace injuries/illnesses.
- Facilitate communication among the injured worker, employer, physician and BWC.
- Follow cases to full resolution, including a timely, sustained and healthy return-to-work.
For more information, refer to the employer's guide or the employee's guide.
How do University Hospitals CompCare's customer service, return-to-work and provider payment services benefit employees, employers and medical providers?
Assigning a customer service representative, nurse case manager and provider relations representative to every client helps University Hospitals CompCare staffers build familiarity with specific cases, clients and industries. As a result, employers, employees and providers receive more timely and accurate information and service from University Hospitals CompCare. Such speed and efficiency pay off on the bottom line, as the employer and provider have fewer administrative headaches, and the injured worker returns to the workplace quicker, thus avoiding long-term, costly disability. Click for more information on our services.
Why are early return-to-work and transitional work so important?
Nationwide, lost-time injuries cost employers more than $10,000 each in direct costs alone. Indirect costs - including costs of employees who assist injured workers, lost production, administrative time, overtime and training - can be 3 to 10 times as much as the direct costs.
An early return-to-work - including the use of transitional duty and working with the employer, employee, MCO and medical provider to implement job accommodations - can save companies money, boost morale, and improve productivity and quality. Several studies have shown that the camaraderie and activity of the workplace actually help people get better faster than they would if they remain out of work.
University Hospitals CompCare's focus is on facilitating a timely, safe and productive return-to-work. Nurse case managers develop individual plans to guide the return-to-work process in even the most difficult cases, and facilitate regular problem-solving contact with the health care provider, employer and injured worker. Check out our information and news you can use about return to work.
What is the difference between an MCO and a TPA?
Under Ohio's Health Partnership Program, the managed care organization (MCO) is responsible for the medical management of work-related injuries and illnesses. Its responsibilities include handling first reports of injury, providing authorizations for medical procedures, processing providers' bills for payment by the state, and driving the return-to-work process. Its staff is clinically focused and includes medical professionals.
On the other hand, a third-party administrator (TPA) covers the legal ramifications of a claim. Its responsibilities include providing legal and risk management advice to employers, litigating claims that the employer feels are unwarranted, and working with MCOs to facilitate return to work. Its staff typically consists of paralegals, claims adjusters, underwriters and statisticians.
In many injury cases, both MCOs and TPAs become involved. Both groups need providers' medical documentation to do their jobs.
How does the prescription medication program work?
University Hospitals CompCare has no role in this program. All questions and concerns about this program should be directed to ACS State Healthcare. The program requires no co-payments. Sometimes, injured workers have to pay for prescriptions upfront, until their claim is processed and approved by BWC. They receive full reimbursement if the claim is allowed. BWC-approved pharmacies have a direct link to the agency, allowing them to find out if a claim has been approved as they are filling a prescription.
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