Managed Care Organization (MCO)

CareWorks is a managed care organization for employer’s workplace injury claims.




Injury Reporting

Customers can report new workplace injury claims to CareWorks by faxing a BWC First Report of Injury (FROI) form to CareWorks, calling us toll-free at 1-888-627-7586 to report over the phone or submit an online FROI by visiting www.careworks.com. CareWorks processes the new FROI through BWC and a new BWC claim number is generated.

Dedicated Medical Management

Each customer has individual CareWorks associates dedicated to their account, helping us develop strong one-to-one relationships with our customers, founded on excellent customer service. Our Case Managers, Case Specialists, Team Assistants and Team Supervisors help injured workers get the appropriate treatment and assistance they need to recover from injury and safely return to work. Each day we strive to provide customer service that exceeds expectations and to make a difference in the lives we touch.

Medical Bill Payment

CareWorks is 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. CareWorks submits providers’ bills to BWC according to set guidelines for the MCO industry and upon final adjudication, makes payments to providers.

Provider Network

CareWorks has enjoyed an exclusive workers’ compensation provider network partnership contract Medical Mutual of Ohio that was first established in 1996. This partnership means CareWorks customers will continue to benefit from all of the workers’ compensation advantages that result from this partnership, including exclusive medical cost savings, strong statewide provider coverage and state of the art bill payment processing.

Alternative Dispute Resolution (ADR)
 
Recognizing the complexity of issues in workers’ compensation cases, a medical dispute may arise as to what services are necessary to treat an injured worker. CareWorks’ dedicated ADR department manages and resolves disputes in accordance with a formal process for dispute resolution.

Return to Work Services

Early return to work has been shown to promote injury recovery, lower claim and medical costs and help employers best control future insurance premiums. CareWorks works one-on-one with employers, injured workers and healthcare providers to develop early return to work programs combat the negative impact of workplace injuries and help injured workers return to productive lifestyles.

Customized Reporting

A complete listing of new injuries, which have been reported to BWC, can be sent to each CareWorks customer on a quarterly basis. These quarterly reports summarize each new injury reported for the quarter and itemize all medical charges, which were paid during the reporting period, and the resulting cost savings. In addition, we work closely with our customers to deliver many other complementary reporting options to help our employers best manage their claims.

Personalized Education and Training

Effective injury reporting and claims management are two integral components of an effective workers’ compensation program. Your individually assigned CareWorks Account Executive is in place to help you learn what steps to take and what procedures to follow should a workplace injury occur. From customized injury reporting packets to BWC forms to early return to work programs, your Account Executive is a great resource to utilize.