For Providers
Policies & Procedures for Providers
How medical providers work with Spooner MAI to treat injured workers under Ohio’s workers’ compensation system.
Getting Started
New employees receive a workers’ compensation identification card specifying the employer and Spooner MAI contact information. Providers should photocopy the card for the patient’s file.
Claim Reporting
Report all claims within 24 hours of initial treatment by phone ((440) 899-2400 or (800) 542-9479) or by fax, providing employee information, injury details, diagnosis codes, employer name, and provider credentials.
Pre-certification of Treatment
Emergency and urgent treatment situations must be reported to Spooner Medical Administrators, Inc. within 24 hours of rendering treatment. We use the Official Disability Guidelines to review treatment and require advance authorization for non-standard treatment.
Alternative Dispute Resolution
Providers may submit written appeals regarding reimbursement decisions. Peer review processes are available.
Referrals
All referrals should go to Ohio BWC-certified providers. Contact Spooner MAI for provider lists or certification information.
Claim Allowance
The Ohio BWC determines the allowed conditions on a claim. Direct questions about allowance to Spooner MAI or the BWC.
Return to Work & Vocational Rehabilitation
Spooner MAI nurse case managers coordinate with providers and employers to facilitate return-to-work programs and vocational rehabilitation services when needed.
Transitional Work
Progressive return-to-work programs gradually increase a worker’s responsibilities — typically within 90 days — using targeted job goals as a therapeutic intervention.
Bill Submission
Submit bills on approved forms per BWC guidelines. Payment follows the Ohio BWC fee schedule. Providers may bill neither the injured worker nor the employer for any difference between the provider’s charge and the amount allowed by the MCO.
Questions about a claim or a bill?
Reach our provider team Monday through Friday, 8:00 AM–5:00 PM.