Same Certification. Different Approach.

Policies and Procedures for Providers

Getting Started

All employees of Spooner Medical Administrators’ customers will have identification cards for workers’ compensation coverage. The identification cards will specify the employer name and policy number, as well as contact information for Spooner Medical Administrators. Photocopy the cards for the patient’s file.

Spooner Medical Administrators will provide employers with a supply of MCO identification cards to distribute to their employees. Additional cards may be obtained by contacting Spooner Medical Administrators.

 

Claim Reporting

All claims must be reported to Spooner Medical Administrators, Inc. within 24 hours of the initial treatment or the initial visit by calling Spooner Medical Administrators, Inc. at 440-899-2400 (800-542-9479) or faxing the claim report to 440-899-2411 (800-542-9480). When reporting a claim, phone or fax Spooner Medical Administrators, Inc. with the following information – the BWC First Report of Injury (FROI) document with supporting medical documentation will meet these requirements:

  • employee name, address, phone number, and social security number
  • date of injury and accident description
  • diagnosis code, causality indicator
  • employer name
  • provider name, address, phone number, tax ID number and BWC certified provider number

Pre-certification of Treatment

Emergency and urgent treatment situations must be reported to Spooner Medical Administrators, Inc. within 24 hours of rendering treatment. Treatment will be reviewed retrospectively. Spooner Medical Administrators uses the Official Disability Guidelines (ODG) as the treatment guidelines for the utilization review process and for return to work management. Treatment not meeting the presumptive approval criteria must be authorized in advance according to the ‘MCO standardized prior authorization table’ found in Chapter 1 of the BWC’s Provider Billing and Reimbursement Manual. The BWC’s Provider Billing and Reimbursement Manual can be found at bwc.ohio.gov

Alternative Dispute Resolution

Spooner Medical Administrators maintains a dispute resolution process that includes peer reviews. If you disagree with a medical treatment reimbursement decision, then submit a written appeal to Spooner Medical Administrators that references the treatment being disputed.

Referrals

All referrals should be made to an Ohio BWC certified medical provider. Contact Spooner Medical Administrators, Inc. to obtain a list of certified providers or for information on becoming certified; for information on referring to non-certified providers and for information regarding out of state providers.

Claim Allowance

The Ohio BWC will determine the allowed conditions for a claim. If you have any questions regarding the allowed conditions, then contact Spooner Medical Administrators or you can contact the Ohio BWC at 1-800-644-6292 or bwc.ohio.gov.

 

 

 


Return to Work & Vocational Rehabilitation

Spooner Medical Administrators employs a staff of professional nurse case managers that will work with the injured worker, medical provider and employer to help an injured worker return to work. Many of MAIs employers will accommodate light duty to help accommodate an injured worker’s return to work so we will work together to create a return to work program. If the injury precludes the worker from returning to his/her former position of employment, then Spooner Medical Administrators will be a link to vocational rehabilitation services.

Transitional Work

The longer an injured worker is off work the harder it is for him or her to safely return to their job. Research shows that transitional work programs help an injured worker recover faster, and provide a safer return to work. Transitional work is a progressive return-to-work program individually designed for the injured worker. It uses specific targeted job goals that gradually increase the injured worker’s restrictions to full duty within a specific time period (usually no more than 90 days). 


Our Nurse Case Management team will work closely with you and the injured worker’s employer to facilitate a customized recovery program that accommodates medical restrictions and limitations. The work that the injured worker does serves as therapy, and will help to speed their recovery process. When necessary, on-site physical therapy can be provided to facilitate a safe return to normal job duties.

 

Bill Submission

Submit all bills to Spooner Medical Administrators on the approved form and following the BWC Provider Billing & Reimbursement Manual guidelines. Claims will be paid in accordance with the Ohio BWC fee schedule. Per Ohio BWC rules, “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.” Spooner Medical Administrators will review all bills for appropriateness, necessity, and cost of the billed charges. For questions on bill payment, contact Spooner Medical Administrators, Inc. You can also log on to bwc.ohio.gov for the most current information on BWC provider billing guidelines including non-covered codes and services.

Download BWC Medical Guide


Contact Us

Have questions about your claims or the workers’ compensation process? Fill out the form below:

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