As part of the Health Partnership Plan (HPP), Providers are to submit all bills for work-related injuries for state funded employers to the proper MCO. Once the status of an injured worker’s claim is determined by BWC, the Provider bill can be processed by the MCO.
When billing for services, use the service codes according to the guidelines in the BWC Billing & Reimbursement Manual. If you do not have a BWC Billing & Reimbursement Manual call BWC at 1-800-OHIOBWC and press 32 or go to the BWC website at www.ohiobwc.com.
The most current Provider reimbursement fee schedule is available on the BWC website at www.ohiobwc.com
All bills are to be submitted on the nationally recognized billing forms:
- American Dental Association (ADA) dental form
- HCFA — 1500
- UB-92
- Service Invoice (BWC C-19)
Self-insured employers are not part of HPP. Self-insured employers will continue to pay for their employee’s workers’ compensation Provider bills and these bills should be sent directly to the self-insuring employer or their represenative.
Billing Dos and Do Nots
Do
Submit bills to the appropriate MCO (If you do not know the proper MCO, go to the BWC WebPage at www.ohiobwc.com and select MCO Lookup)
Do
Submit bills according to BWC format, including the 11-digit servicing provider/pay-to Provider number
Do
Use servicing Provider number in box 25 on HCFA 1500 form or box 11 on C-19 form
Do
Use group or pay-to Provider number in box 33 on HCFA 1500 or box 14 on C-19 form
Do
Indicate diagnosis code on all line items of the bill, regardless of Provider type
Do
Indicate the two-digit place of service code
Do
Follow form completion guidelines in the BWC Billing & Reimbursement Manual
Do Not
Submit bills with the First Report of Injury (FROI) form
Do Not
Balance bill the injured worker
Do Not
Unbundle
Do Not
Submit medical with the bill unless requested by the MCO
Filing Provider Bills
For Health Management Solutions, submit all Provider bills to:
- Health Management Solutions
- 2545 Farmers Drive Suite 400
- Columbus, OH 43235
For questions regarding billing please contact:
Anne Grossman at 1-888-202-3515 x 107, or e-mail at AnneG@hmssolutions.com
