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While a claim is enrolled in the $15K program, Spooner MAI cannot medically manage the claim, approve authorization for treatment, or pay medical bills. Any C-9's received by Spooner MAI will be dismissed with EOB 1010:
This portion of the C9 is dismissed without prejudice as the employer is part of the $15K Medical Only program. This is applicable for DOI on or after 9/10/07. This dismissal is not appealable through the ADR process.
For Bill Payment, bill the employer directly for services related to injuries covered by the $15K program. For claims with a date of injury before July 1, 2009, the employer must either pay the billed charge or negotiate an appropriate reimbursement level. For claims with a date of injury after July 1, 2009, the employer can pay in accordance with BWC's fee schedule. All bills must be paid within 30 days of receipt. When the claim is opted out of the $15K program, Spooner MAI will begin to manage the claim and will process subsequent bills according to the MCO's billing guidelines.
For providers located within the state of Ohio, print the MEDCO-13 or MEDCO-13a form (depending on your provider type) and fax the completed form to BWC Provider Enrollment at the number listed on the form.
For providers located outside of Ohio or if you have a question related to enrollment, call Spooner MAI at 440-899-2400|800-542-9479 and press option #5 to speak to our Billing Department.