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.
All providers must:
1. Have a current license to practice, as applicable;
2. Meet other general certification requirements for the specific provider type;
3. Possess a current and valid Drug Enforcement Agency (DEA) registration, unless not required by the provider’s discipline and scope of practice;
4. Have no previous termination from participation in Medicare, Medicaid or the Ohio workers’ compensation system;
5. Have no felony convictions in any jurisdiction, under a federal-controlled substance act or for an act involving dishonesty, fraud or misrepresentation;
6. Provide proof of adequate, current professional malpractice and liability insurance.
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.
Correct Billing Procedures:
Always submit bills to Occupational Health Link using the Ohio BWC Format
- Use BWC 11-digit Pay To number in box 33 next to GP# on HCFA 1500 form or box 14 on C-19 form.
- Both boxes 33 and 25 must be completed.
- Indicate the BWC claim number on the bill.
- Indicate the diagnosis code on all line items of the bill regardless of the provider type.
- Indicate the HCFA two-digit place of service code. Follow form completion guidelines in the BWC Billing and Reimbursement Manual.
- Insert the BWC Claimant number in the Certficate Number field. The claimant number should be entered exactly as it is assigned by the BWC. Examples of accepted formats include: A 2-digit numeric prefix with a hyphen and alpha prefixes PEL and OD. When entering the 2-digit numeric prefix, include the hyphen. Do NOT insert spaces in any claimant number format.
- Use the BWC Servicing and Pay-To Provider numbers.
- Insert the BWC Claimant Number in the Certificate Number field. The claimant number should be entered exactly as it is assigned by BWC. Examples of accepted formats include: a 2-digit numeric prefix with a hyphen and alpha prefixes PEL or OD. When entering the 2-digit numeric prefix, include the hyphen. Do not insert spaces in any claimant number format.
- Use BWC Provider Numbers.
Incorrect Billing Procedures:
Please try and AVOID the following common mistakes for bill submission:
- Submitting bills with the First Report of Injury (FROI) form.
- Submitting bills with improper coding and diagnoses.
- Balance billing an injured worker.
- Sending medical case management information with a bill.
Each of these requires special handling by the MCO and many times we are at the mercy of the provider making a change to the bill they have submitted. The one that most directly impacts you, the employer, is number five. If an employee brings you a “bill” from a provider, they are most likely bringing you a “statement” which will not contain the necessary information for the MCO to process the bill and may indicate that the provider was not aware that the treatment for workers’ compensation. Please fax those to the billing department so we can do the necessary follow up with the provider.