CareWorks is committed to prompt review and payment of authorized workers' compensation bills. We are responsible for paying provider bills in accordance with applicable rules in the Ohio Administrative Code. CareWorks’ bill payment system tracks the status of provider bills at every stage of the adjudication process. We submits providers’ bills to BWC according to set guidelines for the MCO industry and upon final adjudication, make payments to providers.

In this section you can find general information regarding our services, including:

• Billing Information

• Do's and Don'ts Electronic Billing

• Submission information Contact Information

• Medical Bill Payment & Provider Relations
   

CORRECT BILLING PROCEDURES

Always submit bills to CareWorks using the Ohio Bureau of Workers' Compensation (BWC) format:

1. Use BWC 11-digit Pay To number in box 33 next to GP# on HCFA 1500 form or box 14 on C-19 form.

2. Both boxes 33 and 25 must be completed.

3. Indicate the BWC claim number on the bill.

4. Indicate the diagnosis code on all line items of the bill regardless of the provider type.

5. Indicate the HCFA two-digit place of service code. Follow form completion guidelines in the CareWorks Provider Manual or use the BWC Billing and Reimbursement Manual.

Professional Claims

1. 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.

2. Use BWC Servicing and Pay-To Provider Numbers.

3. Use Payer ID number 10010. ProLINK format - Insert the payer ID number in the Referring Physician name field. This field can be found in the 'D' Record - field 11 (positions 39-43). NSF format - Insert the payer ID number in the first five positions of EA0.22. This is the Referring Provider Last Name field.

Institutional Claims

1. 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.

2. Use BWC Provider Numbers.

3. Insert Payer ID number 10010 in the Payer Identification field. This field can be found in the '30' Record - field 5 (positions 26-30).


INCORRECT BILLING PROCEDURES

Please try to avoid the following common mistakes for bill submission:

1. Submitting bills with the First Report of Injury (FROI) form

2. Balance billing an injured worker

3. Sending medical case management information with a bill.