Answers to your questions about MCO open enrollment

By Jason Bainum, Manager of Marketing & Member Services

Part of my job at the Columbus Chamber is to manage the savings programs for our members. One of our key programs is for workers’ compensation managed care.

The Managed Care Organization (MCO) open enrollment period runs May 3-28. There has been some confusion regarding the program, so we’ve put together this list of frequently asked questions to help our members better understand their option.

When does the open enrollment process begin and end? 
The 2010 MCO open enrollment period began at 7:30 a.m. May 3 and ends at 5:30 p.m. May 28

Whom does the Columbus Chamber endorse as the preferred workers managed care organization?
The Columbus Chamber endorses CareWorks, a BWC certified Managed Care Organization (MCO), as the preferred partner for workers’ compensation managed care services. We selected CareWorks after a thorough analysis of several MCOs.

Do I need a managed care organization?
Yes, State fund employers have two opportunities to select a managed care organization (MCO).

•    A new employer has approximately 30 to 60 days to select an MCO. The new employer will receive a new employer kit. Included in this kit is an MCO selection guide. This guide provides instructions to the employer on how to select a managed care organization (MCO) to medically manage their workers' compensation claims. If the employer does not choose, the Ohio Bureau of Workers’ Compensation (BWC) may automatically assign an MCO.

•    The second opportunity an employer has to select an MCO is during open enrollment. This only occurs once every two years. If an employer does not want to change MCOs, then no action is required.

Do I pay a fee to the Managed Care Organization?
No, there are no direct costs for MCO services. MCO fees are included with an employer’s BWC premium.

Are there fees for Third Party Administrative services or to join a group rating program?
Yes, there is normally a fee to participate in a group plan or hire a third party administrator to manage an employer’s claims.

What is the difference between a Managed Care Organization and Third Party Administrator?
MCOs are responsible for the medical management of Ohio employers’ work-related injuries and illnesses. Every employer in Ohio must have an MCO, which is paid for directly by the BWC. TPA is responsible for the administrative and financial aspects of the employers workers’ compensation program. Employers pay for these services.

If you are responsible for your workers’ compensation program, it is important to have a fundamental understanding of the roles of a MCO and a Workers’ Compensation Third Party Administrator. Both MCOs and TPAs play important roles in helping employers control workers’ compensation costs.

You can read about the Chamber’s MCO program on the Chamber’s website.

If you have any question, please contact me at 614.225.6949 or jason_bainum@columbus.org.