The MCO Policy Reference Guide is available on this Web site for any of BWC's customers. The manual is updated quarterly to provide information about policies and procedures for BWC and MCO staff.

Note: If you have arrived on this Web page as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the materials unless you read, agree to and abide by the provision of the copyright statement.
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IMPORTANT: As we continue the transition to ICD-10, we will need to update our policy and billing reference materials. We will make those updates as we convert specific policies to our technical format. In the meantime, treat any references to ICD-9 in these documents as ICD-10.

To download a specific chapter, click on the chapter title. If you want to download the entire manual, click on each chapter title and download each chapter one at a time.

• Table of Contents
• Chapter 1 - General Information
• Chapter 2 - Claims Management Information for MCOs
• Chapter 3 - Medical and Return to Work Management
• Chapter 4 - The Role of Vocational Rehabilitation in Ohio's Workers' Compensation
• Chapter 5 - Alternative Dispute Resolution (ADR)
• Chapter 6 - Provider Relations
• Chapter 7 - BWC Pharmacy Department
• Chapter 8 - Coding and Reimbursement Standards
• Chapter 9 - New/Revised/Updated Policies
• Appendix I - Provider Requirements for Enrollment
• Appendix II - 148 Data Element Timeframes
• Appendix III - Explanation of Benefits Table
• Appendix IV - Medical policy documentation guidelines

Policy alerts
BWC will periodically issue policy alerts to provide further clarification on specific policies. To download the latest policy alerts, click on any of the links below.

Home health

• MCO Medical Management of Home Health Agency Services

Prosthetics

• 2017 BWC Prosthetic Coding Clarification, Pricing Methodology and Invoice Requirements

Recovery of overpayments

• Clarification as to when to use the alternative dispute resolution (ADR) appeal process in overpayment recovery

Vocational rehabilitation

• The use of BWC ergonomists when the service is requested on a Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) or a vocational rehabilitation plan