Managed Care Organization

What is a MCO?

Under Ohio's Health Partnership Program, managed care organizations (MCOs) are responsible for the medical management of Ohio employers' work-related injuries and illnesses.

Every state-funded Ohio employer can select a MCO of their choice to medically manage their claims. Employers not selecting a MCO will have one randomly assigned to them by the Ohio Bureau of Workers' Compensation (BWC). Furthermore, employers are limited in their ability to change MCOs and, in most circumstances, can only do so during an MCO Open Enrollment period – which are customarily held only one month every other year.

A MCO is responsible for handling all matters related to medical treatment for approved Ohio workers' compensation claims. MCOs provide a number of services, all to assist Ohio employers and their injured employees in successfully recovering from a workplace injury and returning to work.

The core MCO functions include:

  • Collecting initial injury reports and transmitting to BWC;
  • Management and authorization medical treatment to be received by an injured worker;
  • Medical review and bill payment processing;
  • Maintaining a network of BWC-certified healthcare providers;
  • Return to work services;
  • Utilization review;
  • Processing treatment appeals;
  • Providing an Alternative Dispute Resolution (ADR) process; and
  • Training and education.
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