(A) An injured employee may seek medical care for an industrial injury from one of three types of providers:
(1) A bureau-certified provider who is an MCO panel provider for the employer's MCO;
(2) A bureau-certified provider who is not a member of the employer's MCO panel, but who will be managed by the MCO;
(3) In limited circumstances, a non-bureau-certified provider, subject to an employee's payment responsibilities as delineated in rule 4123-6-12 of the Administrative Code.
(B) At the time of an injury, the employee may seek medical care directly from an MCO panel provider or through the MCO. If contacted directly by the employee, the MCO may refer the employee to a provider. The MCO shall immediately inform the employer and the bureau of the contact by the employee.
(C) If the employee seeks medical assistance from a provider, the employee shall inform the provider of the employee's MCO. The provider shall then notify the MCO of the contact by the employee. If the provider is a bureau-certified provider, the provider must agree to provide treatment pursuant to the MCO's guidelines. If the provider is a non-bureau-certified provider, the provider will be informed by the MCO that the care for the first visit will be compensated by the MCO if the claim and the treated conditions are subsequently allowed. The MCO will inform the non-bureau-certified provider that no further treatment will be authorized.
(D) An injured employee may continue treatment with a non-bureau-certified provider under two circumstances:
(1) The provider may apply to the MCO for emergency credentialing as necessary for care and services that are unavailable through like MCO panel providers, or
(2) The employee may continue to treat with a non-bureau-certified provider, but at the employee's own expense without recourse against the MCO, employer, or bureau.
Effective date: Feb. 16, 1996