How to Choose the Right MCO

Posted By Brandy King
March 28, 2023 Category: General

Every two years, Ohio employers in the state fund (paying premiums to Ohio BWC) are permitted to choose the MCO (managed care organization) they'll work with for the next two years, and maybe far beyond that. Not every employer has had an interaction with their MCO, so let's start with the basics. What is an MCO? MCOs are contracted through Ohio BWC to manage the medical aspect of employee work-related injury claims. They are paid by Ohio BWC with a portion of employer-paid premiums. What should an employer look for when selecting an MCO? A utilization review department that is separate from the case management department is key. This helps an MCO maintain impartiality and make objective decisions when responding to treatment requests by doctors to determine their appropriateness in the context of a claim. An MCO needs a comprehensive fee-auditing department to determine what claims are appropriate to pay. A company should feel confident that their MCO’s process is thorough enough to avoid unnecessary charges. Companies benefit from MCOs that have a relationship with a provider network. This enables it to take advantage of discounts below the BWC’s fee schedule. Lower medical costs equate to lower workers’ compensation premium payments. Customized reporting is an added perk, as such reports can contain incredibly valuable information - like how to target and engineer out certain injury types with better safety or ergonomic programs. An emplo