Same Certification. Different Approach.

Workers Compensation Managed Care Polices and Procedures

Getting Started

All workers must have identification cards specifically for workers’ compensation coverage. The identification cards will specify the managed care organization (MCO) contracted by the employer and important telephone numbers.

Workers' Compensation Managed Care Policies & Procedures for Employers

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.

When Injury Occurs | Spooner MAI

When an Injury Occurs

Early reporting is essential to reducing workers’ compensation costs. Injured workers must be given effective treatment before an injury becomes more serious or before more damage is done. Be sure to report injuries to Spooner Medical Administrators as soon as you are aware that an injury has occurred. We can then assist in getting the injured worker quality treatment which will foster a timely return to work.

What steps should be taken in the event of a work-related injury?

  • When an employee is injured, assist him/her in:
  • Completing an injury report
  • Selecting a medical provider
  • Seeing that he/she has their Spooner Medical Administrators MCO ID
  • Understanding that they must present the MCO ID card to their medical provider

Choosing a Medical Provider

Spooner Medical Administrators works with excellent BWC certified doctors who share the goal of providing quality medical treatment and returning workers to the job safely. Injured workers may seek medical care from any BWC certified doctor. If needed, Spooner Medical Administrators can assist with finding a doctor. Telephone referrals will be available from Spooner Medical Administrators during office hours: Weekdays 8:00 AM - 5:00 PM.

Injured workers who seek treatment from a doctor who is not BWC certified will have to pay for those services out of their own pocket. Any doctor is eligible to apply for BWC certification and Spooner MAI will help obtain an application for any doctor.

In a medical emergency, the injured worker may seek treatment from a BWC enrolled, non-certified doctor and the cost of the initial treatment will be covered once the claim is allowed by the BWC.

 

 

Choosing a Medical Provider


Submission of Claims | Spooner MAI

Submission of Claims

Claims should be submitted by employees in the same way they have been in the past. The MCO does not change that aspect of your workers' compensation program. Your relationship with your third-party administrator, if you have one, will remain unchanged.

Payment of Medical Bills

Injured workers are not required to pay the doctor for treatment for allowed claims. Keep in mind that only the Ohio BWC can determine whether or not a workers’ compensation claim is approved and for what medical conditions. Medical payments will not be paid until the claim determination is made by the BWC. If an injured worker has paid for medical services from a BWC certified doctor out of pocket for an allowed workers compensation claim, they then may be reimbursed by submitting proof of payment to Spooner Medical Administrators. Compensation checks for lost time are processed by the Ohio BWC.

The Role of Employers in a Return to Work Program

The employer’s role is to provide the information needed for medical providers to effectively evaluate the injured workers’ ability to perform his/her job and to assist in developing modified or alternative work arrangements when they are recommended.

Spooner MAI LogoThe Role of Spooner Medical Administrators

Spooner Medical Administrators, Incorporated is an MCO authorized by the BWC to provide employees with medical management services. Our services include case management, prior authorization for medical treatment and payment of medical bills. Managed care procedures were designed to promote quality care while controlling costs.

The worker’s compensation program utilizes:
  • Pre-certification of treatment to ensure that the most effective treatment is being utilized. The employer, employee, or their representative can appeal any treatment reimbursement decision made by Spooner Medical Administrators.
  • Utilization management to ensure that appropriate provider billing in relation to diagnosis and treatment occurs. Spooner Medical Administrators’ qualified billing staff will audit all medical bills.
  • Quality assurance methods which review and/or manage selected cases to promote the best course of treatment and to coordinate the efforts of providers.

Contact Us

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