Welcome health-care professionals

We invite you to use this page to learn about the Ohio Bureau of Workers’ Compensation (BWC). Discover the teams dedicated to supporting you as you care for our injured workers, find vital resources, and stay up to date on the latest BWC news.

BWC medical goals

• Maintain and enhance medical and vocational services benefit plans and reimbursement rates.
• Enhance effective administration of managed care and return-to-work services.
• Ensure clinicians provide appropriate, high-quality, and cost-effective care.
• Prevent inappropriate use of medications.
• Measure and improve care outcomes.
• Maximize positive injured worker outcomes through coordination of care and case management.

BWC Chief Medical Officer Dr. Brad Lewis

The Chief Medical Officer partners with providers to develop policy, oversees the medical program, and uses a team-based approach to create strategies and develop policy to ensure prompt, quality, safe, cost-effective care for Ohio’s injured workers.

BWC Medical Services and Compliance

BWC’s Medical Services and Compliance Division is led by Freddie Johnson. The areas supporting our providers include:

• Alternative Dispute Resolution (ADR)
• Compliance & Performance Monitoring (CPM)
• Disability Evaluator Panel (DEP)
• Managed Care Organization (MCO)
• Medical Billing & Adjustments (MB&A)
• Medical Reimbursement & Coding Policy
• Provider Experience
• Transitional Work
• Vocational Rehabilitation

What's new at BWC!

BWC will reimburse for diagnostic tests: EMG, NCS, epidural injections, nerve blocks, and medical imaging

BWC recently amended Rule 4125-6-16.2 to allow for payment of diagnostic tests.

Diagnostic testing will be reimbursed when medical evidence shows they are medically necessary to develop a treatment plan for an allowed condition or to pursue more specific diagnoses reasonably related to an allowed condition. Medical providers need to submit a Physician’s Request for Medical Service Reimbursement) (C-9) and indicate the test is being conducted for diagnostic purposes.

If you feel a request has been inappropriately denied, please contact the managed care organizations (MCO’s) medical director.

New! Provider enrollment online

Providers can now apply for BWC certification online! The process takes minutes, ensuring quick processing and reimbursement.

To apply or learn more, visit the Application for provider enrollment and certification (MEDCO-13).

Get started today and take control of your experience!

BWC regional provider engagement director

Our regional provider engagement directors offer personalized concierge services to your practice! As a BWC-certified provider, you receive:

• A direct BWC contact, offering individualized support and resources for your practice.
• Updates on news and policies through your dedicated BWC liaison.
• Resources and training to simplify workers’ compensation.

Our BWC-certified providers are essential to ensuring injured workers receive the quality care they need efficiently. Email your Regional Provider Engagement Director today!

BWC Provider Billing and Reimbursement Manual (BRM) has a new look

The Provider Billing and Reimbursement Manual (BRM) explains the billing procedures for medical providers treating injured workers under the Health Partnership Program. The BRM is now searchable by policy. We also publish a highlights document to easily identify recently published policy updates and changes.

Providers can submit bill adjustment requests electronically

Providers can now submit requests to void or adjust previously submitted bills electronically. Working with your Managed Care Organization (MCO), requests can be submitted using electronic data interchange (EDI). Previously MCOs could only accept written requests.

Learn more in BWC’s Adjustment and Void policy found in the Billing and Reimbursement Manual.

How to recommend an additional allowance

• Use Request for Medical Service Reimbursement or Recommendation for Additional Conditions (C-9) form. Include:
  • Diagnosis: Provide a narrative description with location and site. Include laterality.
  • how the additional condition is related to the work injury, supported by objective evidence.

BWC’s Pharmacy program

On Oct. 1, 2024, BWC implemented a new, more secure Pharmacy Benefit Manager (PBM) that now allows for 90-day supplies of medications.

Things to know!

BWC publishes all reimbursement schedules on the BWC website

• Providers can review the current year’s fee schedule, as well as the prior two year’s fee schedules on BWC’s website.
• Providers are proactively notified of proposed annual fee schedule updates for each applicable fee schedule in May, July, and October of each year.

BWC reimburses at a premium

• BWC reimburses above Medicare’s base rates. The payment adjustment factor, or the percentage BWC uses to increase reimbursement is published with each fee schedule.

BWC provides look-up tools for fee schedules and explanation of benefits

• BWC provides efficient look-up tools for providers to obtain professional reimbursement for up to five procedure codes or five explanation of benefit (EOB) codes at a time.
• Both the Fee schedule look-up and Explanation of benefits look-up give providers real-time data responses.

Enhanced Care Program (ECP)

• Offers additional Reimbursement
• Physicians providing exceptional care have an opportunity to earn a 15-percent incentive payment
• Subject to fewer authorization requirements.
• The enhanced care program (ECP) allows physicians the ability to treat causally-related conditions without having an explicitly allowed condition.

Interested in learning more, call our BWC Provider Contact Center 1-800-477-2292 or Go to the “PROVIDERS” section on the Ohio BWC Website.