Online Orientation
We are pleased to announce that our new and improved online Self-Insured Orientation Tutorial is now available. The tutorial is a convenient way to learn the basic requirements for managing self-insured programs. We encourage anyone new to self-insurance or just looking to refresh your knowledge to view the tutorial. You can access the tutorial through our learning center. You will need to set up an account with the learning center using your existing state fund or self-insured policy number. Simply search “SI orientation” once you have accessed the learning center site. You can download more detailed instructions here. This tutorial discusses differences between self-insurance and state fund claims management, basic claims requirements including wage calculations, claim reporting requirements and time frames, and the Industrial Commission hearing process. We ask that all new designated administrators complete the tutorial to better understand the administrative requirements for self-insured programs.
Prosthetics for Self-Insuring Employers
BWC is responsible for processing requests and payment for prosthetics on self-insuring employers’ claims. However, while you should not approve C9 requests specifically for prosthetics and related equipment, you need to continue to manage the claim and treatment for the injury.
It is imperative that the documentation listed below be submitted to BWC and imaged in the claim so we can expedite our responses for the C9s requesting prosthetic devices and/or supplies. These records can be faxed to 1-866-366-8352 with the BWC claim number.
- A C9 dated and signed by the attending or a consulting physician who has seen the patient within the last six months. If you receive the C9 directly, please forward to CAT.Nurse.Referrals&Questions@bwc.state.oh.us upon receipt. Do not respond to these requests.
- A detailed medical summary from an office visit from the provider who signed the C9 within six months of the request.
- The C9 should include the appropriate L codes for the associated requested device and/or supplies. The L codes are available at https://hcpcs.codes/l-codes/ .
- The name of the prosthetic vendor requesting the device and/or supplies.
- The original operative report as well as any additional operative reports of any surgical revisions that have been necessary throughout the life of the claim.
- Scheduled loss award and documentation.
Once the requests are approved, we will address the following:
- In some cases, as in accordance with the Artificial Appliance Policy OAC 4123-6-08, a multidisciplinary evaluation (MDE) will need to be scheduled with The Ohio State University Department of Rehabilitation. This exam will determine the necessity of the requested prosthetic device. The Subject Matter Expert (SME) in prosthetics within the CAT department will assist the SI Case Manager in scheduling the exam and obtaining the exam summaries.
- We will require detailed invoices from the prosthetic vendor with all appropriate L codes to include miscellaneous codes as well as pricing. (All miscellaneous codes will require a detailed explanation as to why the miscellaneous codes are being utilized as well as a manufacturer’s invoice before reimbursement can be considered).
For any questions or concerns, please reach out to James Landon, RN, SME Prosthetics at james.l.14@bwc.state.oh.us or call at 614-440-4202.
Proposed rule changes
We are currently conducting a five-year rule review of self-insured rules in OAC 4123-19 and our proposed changes include the following:
OAC 4123-19-03(K) (5) – Clarify time frame when ordered benefits must be paid upon receipt of an Industrial Commission order awarding compensation. Recommending that compensation be paid within fourteen days of receipt of the order awarding compensation.
Also, clarify response requirements to a change of physician request. We recommend that employers may question the change of physician request for non-medical reasons and allow the injured worker to resolve the issue. Employers shall not interfere with an injured workers free choice of physician.
OAC 4123-19-03(K) (3) and (4) – Employers shall update allowed conditions on BWC’s claim system within 30 days of any changes in allowed conditions in a claim.
OAC 4123-19-03(K) (9)– Clarify requirement to make the claim file available to claimant or claimant’s representative within 72 hours of a written request. Add that employers should provide copies of requested claim information, benefit payment history, wage history, confirmation of allowed conditions, or any other specifically requested information within 72 hours of receipt of a written request.
Please feel free to contact Dave Sievert at david.s.14@bwc.state.oh.us or Dave Boyd at David.Boyd.SI@bwc.state.oh.us with comments or questions about these proposed changes.
Self-insured workshops
We are planning online workshops for 2022, focusing on specific topics of interest. This will include the Basic Self-Insured Requirements, Prosthetics, and Pharmacy Benefits. Stay tuned for more details. Please let us know if you have topics you would like to see us discuss.
2022 compensation rates
The Statewide Average Weekly Wage, or the Maximum rate for compensation other than percentage of permanent partial awards, will be $1,085 for injuries occurring on or after January 1, 2022. The minimum rate will be $361.67. The maximum percentage for permanent partial awards will also be $361.67, and the Disabled Workers’ Relief Fund (DWRF) entry level will be $425.67 weekly.
Important Dates
January 27, 2022- Assessments available online and mailed to employers.
February 28, 2022- SI 40 report and SI 40 backup detail report due.
February 28, 2022- Assessment payments due (must use online payment method.)
We wish you a happy holiday season and prosperous New Year!
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