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Provider COVID-19 update: Provider certification lapsing reinstated
Our certified provider network is eligible for recertification every three years. As we shared in our May edition of Provider eNews, we continue to invite providers to recertify during the COVID-19 state of emergency.
Since late March, we have mailed nearly 5,500 certified providers a recertification application. We normally allow up to 90 days to receive a recertification application before lapsing a provider’s certification.
Since March, we have not lapsed providers who did not respond to the recertification application. We made this decision as we knew medical offices closed quickly and provisions for mail were not completely in place.
At this time, most medical offices have reopened, and mail provisions are now in place. Based on this, beginning in September, we will restart lapsing providers’ certification if they do not respond to our recertification-application process.
We have taken additional steps to contact providers who have requested reimbursement but have not returned their recertification application. We made this contact because we typically deny reimbursement when a provider’s certification status is lapsed.
If your certification lapses, you should complete and submit an Application for Provider Certification (MEDCO-13) to us for processing. Upon receipt and approval, your certification status will be retroactive to your lapsed-certification date.
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A more user-friendly web experience is almost here!
BWC is getting ready to launch a redesigned website to better serve you and our injured workers and employer customers. Planned for implementation on the evening of Aug. 18, our website will have a similar look and feel to other State of Ohio agencies’ sites.
For more information on the website’s enhanced tools, features and functions, here is the July Provider eNews story.
Our website address remains bwc.ohio.gov, and our Provider Contact Center associates can help you with any navigation issues. You may email or call 1-800-477-2292.
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BWC issues new provider number for improved service
We are making an important change when issuing provider-identification numbers to offer you better customer service and to ensure your sensitive data is secure.
We heard your concerns about our past method of using either your federal employer tax identification number (EIN) or your Social Security number (SSN) as the base number, so we created a workable solution.
Your new provider-identification number is a systematically, random-generated number and will not contain as a base either your EIN or SSN. This assigned number can replace your current BWC provider number on all forms or bills. If you are eligible to receive a National Provider Identifier (NPI), use your NPI when billing.
We will be notifying active providers of their new provider-identification number this fall. For updated identifier information, read next month’s Provider eNews.
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Upcoming webinar: Vocational Rehabilitation Fee Schedule Updates
By viewing our informative, live webinar, you will learn more about the 2020 changes to our vocational rehabilitation fee schedule that are effective Oct. 1. Register now for the Vocational Rehabilitation Fee Schedule Updates webinar we’re offering from noon to 1 p.m., Sept. 10.
You will see a new look and feel to our published fee schedule. During the webinar, our team will navigate you through the site to help you learn where to find service definitions, reimbursement impacts, and fees.
In addition, you will learn how to bill for services where codes were consolidated. Note that there were no payment changes in the rule, but there were service-definition changes you may need to review.
If you miss the live webinar – don’t worry. A recording will be available on our website’s Provider Videos page by Sept. 16. For more information, email our rehab policy department
Rules review under way for select medical rules
State agencies must review Ohio Administrative Code (OAC) rules at least once every five years. Certain rules, such as the medication formulary, are updated more often as needed.
The following significant changes are expected to take effect Sept. 1. Here are important updates from the pharmacy and credentialing requirements rules.
New in the pharmacy rules
OAC 4123-6-21.7
A new reimbursement rule for opioids. It will refer to the State of Ohio Medical Board rules for prescribing opioids, OAC 4731-11-13 and OAC 4731-11-14. Reimbursement for opioids will be limited to claims where current best medical practices listed in the medical board rules are followed and documented. No longer required are the former documentation list requirements for opioid dose exceeding 50 morphine equivalent dose (MED) per day or beyond six weeks of the injury date.
OAC 4123-6-21.8
Rule allows for reimbursing services to assist in discontinuing medications that may increase the risk of dependency, misuse, and substance use disorder.
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Outpatient formulary additions
Aimovig®, Emgality®, and Ajovy®
may be approved upon a request for prior authorization. Approval will be considered if migraine is an allowed condition in the claim and there has been a clinical failure or allergy to at least three of the following preventative medications: topiramate, sodium valproate, divalproex sodium, amitriptyline, venlafaxine, atenolol, metoprolol, nadolol, propranolol, and timolol.
Aubagio®
may be approved for injured workers who have multiple sclerosis allowed in their claim.
Flector® patch
may be approved upon a request for prior authorization. Approval will be considered if there is an intolerance, contraindication, or clinical failure to at least two other NSAIDs on the formulary. Reimbursement will only be approved for 12 weeks post injury, as they are not indicated for chronic use.
Lidocaine 4% topical solution.
Outpatient antineoplastic drugs for treatment of an allowed cancer condition in a claim. Prescriptions exceeding $3,000 or requests for off-label use will require prior authorization.
Modifications to coverage on the outpatient formulary
Pregabalin (Lyrica®) will no longer require a trial and failure of gabapentin. The three capsule per day and 600 mg. per day limits will still apply.
New to the provider certification criteria rule
OAC 4123-6-02.2 lists category specific requirements for certification. We will not allow providers with denied, revoked, or suspended Ohio licensure to be certified, even if they are allowed to practice in another state. We added a rule appendix for specific convictions that tiers the exclusion times based on the crime. Felonies and other convictions formerly permanently excluded may no longer be permanently barred. Employment specialists will have additional credentials to qualify. They will be on the same rotation to recertify as others, and waivered providers that lapse certification will not be eligible to participate via the waiver.
We have a website section for the public called Rules Under Review, which shares current board-approved rule changes proceedings through to the final public hearing at the Joint Agency on Rule Review. When that step is completed, we set effective dates.
If you have questions, email feedback.medical@bwc.state.oh.us.
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We will present our 10th annual Fallen Workers Memorial by video through the Ohio Channel website beginning Sept. 3. Due to COVID-19 restrictions, a live in-person event was not possible. Each year this event gives us the opportunity to honor Ohioans who lost their lives while on the job.
BWC Administrator/CEO Stephanie McCloud will host the 30-minute program, which features BWC Board Chairman Chan Cochran, Board Directors Michael Taylor and Peggy Griffith, Ohio Industrial Commission Chairman Jim Hughes, and Ohio Contractors Association President Chris Runyan. The program will conclude with reading the names of the fallen, followed by a moment of silence and then three tolls of the memorial bell.
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We continue to serve you during the COVID-19 state of emergency with teams teleworking to assure our core operations for Ohio’s injured workers and employers are as smooth as possible.
Below are some recent updates.
- Under Governor Mike DeWine’s direction, we launched Protecting Ohio’s Workforce – We’ve Got You Covered. On May 20, we began sending millions of non-medical-grade face coverings to employers and their workforce as many return to the workplace for the first time since COVID-19 emerged in Ohio. As of July 31, we have shipped 13.4 million face coverings to 184,000 employers. We are sending more as we secure additional supplies. We’re also setting an example by wearing our masks no matter where we work or live. When we’re out in public – Masks On!
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- We are also sponsoring two public service announcements (PSAs) encouraging Ohioans to wear masks in public to weaken the spread of COVID-19. Governor DeWine announced the campaign during his July 22 press briefing, after announcing his order that all Ohioans wear a mask in public. The first PSA, titled “Why I Wear a Mask," features real Ohioans explaining why all Ohioans should wear a mask.
- The second PSA, simply titled “Markovich” features Dr. Steven Markovich, a former Air National Guardsman and fighter pilot, who is CEO of OhioHealth. He encourages younger adults to wear masks to protect family, friends, and coworkers. Please share these videos with your patients, employees, and local community.
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- As a precaution to mitigate the spread of COVID-19, we had to cancel our 2020 Medical & Health Symposium. Our exhibitors are an important component of our event. This year, our exhibitors represented rehabilitation hospitals, health management, and drug disposal systems, as well as managed care, physical therapy, and more.
Although you could not visit these exhibitors in person, we have created a Medical & Health Symposium Exhibitor Guide that lists each exhibitor. It provides information with links to the exhibitors’ websites. Feel free to contact each exhibitor directly if you have any questions or would like to learn more about the products they offer to better serve Ohio’s injured workers.
Planning has begun for the 2021 Medical & Health Symposium. Stay tuned for additional details in upcoming editions.
- We created a special team to handle the newly filed COVID-19 claims to provide them with careful attention.
We’re not done. These efforts continue. Remember – We are #In This Together Ohio.
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