Medical providers with few exceptions, rendering services in Ohio must be BWC-certified to participate in the Health Partnership Program (HPP). Certification is based on licensing, certification and accreditation requirements necessary to provide services as well as other minimum credentials based on provider type.

Billing Procedures

Occupational Health Link is committed to prompt review and payment of authorized workers’ compensation bills. We are responsible for paying provider bills in accordance with all applicable rules in the Ohio Administrative Code. We submit provider bills to BWC according to set guidelines for the MCO industry and upon final adjudication we make payments to providers. The Occupational Health Link bill payment system tracks the status of provider bills at ever stage of the adjudication process.

Billing Submissions Timeline

Billing Submissions must be timely. Ohio Revised Code (ORC) 4123.52B and Ohio Administrative Code (OAC) 4123.3.23 set forth billing and adjustment request timelines and are noted in the table below:

General Form Instructions

National Standard Practices

Forms shall be filled out in accordance with national standard practices except as noted.

Information For Workers’ Compensation

Providers cand include information not typically needed for workers’ compensation. This information will be ignored if it is not pertinent to determining eligibility for reimbursement.

Do Not Alter Forms

Forms shall not be altered in any manner (customized by adding lines, etc.) Do not enter two lines of information in one block.

Number Of Provider IDs Submitted Per Bill

Only one servicing (treating) provider ID may be submitted per bill.

BWC Claim Number

The BWC claim number must be noted on the bill.

National Correct Coding Guidelines

A provider should bill in accordance with national correct coding guidelines. All of the information should be typed, not handwritten. If it is computer generated, use letter quality forms.

Paper Billing Forms

All paper billing forms should be submitted flat, not folded.

Use Paper Clips

To avoid tearing forms, use paper clips. Do not use staples.

Documents & Modifiers

Do not attach documents unless requested or billing unlisted procedures and modifiers.

Do Not Use Products To Mask/Hide Text

Do not use correction fluid, correction tape or markers.

Submit Current IRS Request For Taxpayer Identification Number & Certification (W-9)

In order to ensure correct information on your internal Revenue Service (IRS) 1099 form, please submit a current IRS Request for Taxpayer Identification Number and Certification (w-9) form to BWC’s Provider Enrollment.

Taxonomy Code Information

If applicable, providers may include Taxonomy Code information. Taxonomy Codes are not required in BWC billing but may be helpful in cross-walking the National Provider Identifier to the BWC Provider number.

Professional Claims

Current Version Of CMS-1500 – The provider shall use the most current version of the CMS-1500
CMS-1500 Line-Item Number 24A (Date(s) of Service) – The provider should enter the beginning date of service in month, day, and year format. BWC will not accept any medical bill that contains more than one (1) date of service per line item. Line items that contain a different “From” and “To” date will be denied with the following: “EOB 269 – Payment is denied as BWC allows only one date of service per line item.”
CMS-1500 Line-Item Numbers 24I, 24J, 25 & 33 – The provider should pay special attention to instructions for completing line-item numbers 24I, 24J, 25 and 33, which are used in determining provider eligibility in bill processing and financial reporting to the IRS.
CMS-1500 Line-Item Numbers 14, 21, 24F, 24I, 24J, & 33B – The provider should complete the form in its entirety to ensure the provider follows the BWC-specific instructions for the items listed below (Note: The numbers listed below correspond with the line-item numbers on the form):

Health Insurance Claim (CMS-1500)

Registering National Provider Identifier – The provider must register the provider’s National Provider Identifier with BWC before submitting bills with National Provider Identifier. Billing a provider using the same National Provider Identifier for multiple locations must ensure that BWC has the accurate address information on file for each billing location.
Changing Provider Information In BWC Records – To make any changes, additions or corrections to the provider information as it is recorded in BWC’s records, the provider must submit a written request on company letterhead to Ohio BWC Provider Enrollment at fax number (614) 621-1333 or the following address:
Ohio BWC Provider Enrollment
P.O. Box 15249
Columbus, OH 43218-2031
Cross Reference ANSI X12 ASC 937 – Please use cross references to the ANSI X12 ASC 837 (i.e., American National Standard Institute (ANSI) X12 Accredited Standards Committee (ASC) 837 (i.e., standard format for transmitting health care claims electronically)) standard in the National Uniform Claim Committee (NUCC) instructions as the guideline for submitting electronic bills. Click here to obtain contact information for electronic transmission to the MCO.

Facility Claims

Hospital & UB-04 – BWC will only accept UB-04 form from a hospital. Other provider types that may be able to bill Medicare or Medicaid on a UB-04 should refer to the Provider Bill Type Form REquirements list noted in Section II of this chapter.
National Provider Identifier Number & BWC 11 Digit Provider Number – A hospital should use the UB-04 when submitting bills for workers’ compensation services.
The hospital may use the hospital’s National Provider Identifier number or BWC’s 11 digit provider number when billing.
Coding Clinic Of The American Hospital Association – A hospital must submit hospital bills in accordance with the correct coding guidelines per the CodingClinic of The American Hospital Association. Failure to do so may result in an incorrect reimbursement calculation.

Medical Documentation Requirements – See Chapter 2 medical documentation requirements.
Split Cycle Bills – Split cycle bills with overlapping dates of service will not be accepted.
UB-04 Line-Item Numbers 14, 21, 24F, 24I, 24J, & 33B – The provider should complete the form in its entirety ensuring that it follows the BWC-specific instructions for the items listed below (Note: The numbers listed below correspond with the line-item numbers on the form):

Delays in Billing

Improper billing form. Please use the HCFA 1500 of the UB92 or a BWC approved form to submit charges. Please assure that the correct place of service and type codes are used.
This claim is self-insured and the company is responsible for paying the invoice.
The claim number is missing or invalid.
The ICD-10 code is missing or invalid.
The procedure code is missing or invalid.
Pay to provider number in Box 33 is missing or invalid. This number is required in order for the invoice to be submitted to the BWC.
Individual provider number in Box 25 is missing or invalid. If you are a group practice, this number is required in order for the invoice to be processed.
Occupational Health Link is not the MCO for this injury.
The charges are for an injury that the MCO has no record of, please submit with proper medical documentation, including FROI. All BWC Providers are to report injuries to the appropriate MCO within 24 hours of treatment.
This claim has been disallowed by the BWC. Injured worker is responsible for the bills.

Injured Worker

As an Injured Worker weaving through the Workers’ Compensation field can be a daunting and frightening experience, but as a Managed Care Organization (MCO) who is owned and run by a team of providers, our main focus is to provide quality and affordable health options. Our main goal is to help you return back to work, fully functional.

Employer

OHL is owned and directed by some of Ohio’s leading Occupation Health Providers. We are the people who take care of you when you are injured and our goal is to provide the quality and affordable care your injured worker needs.