Entering State of Ohio Workers' Compensation Claims in Misys – Follow these steps and your claims won’t get hurt!

It's not that entering worker's compensation charges is all that difficult.  What makes workers compensation claims such a challenge is that they require the cooperation of several parties and are comprised of multiple steps which include, obtaining information to file the First Report of Injury (FROI), getting a claim number from the Bureau of Workers' Compensation (BWC) and getting paid for your services.  And as we know, getting outside parties to cooperate is never easy!

The FROI requires sections to be filled-out by the three parties to the claim: 

1. The injured employee
2. The employer
3. You, the provider of services to the injured employee

The good news is that in today's Internet era, most of the information for the FROI report can be entered directly via the web at the state of Ohio’s Bureau of Workers' Compensation website.  We’ll show you where to go later in the article.

Once the FROI is completed, the next hardest thing to do is to correctly identify the employer for data entry into Misys as either: 

1. An employer who is "self-insured" with claims getting sent to the employer or
2. One who participates in a Managed Care Organization (MCO) so bills get there

EXAMPLE CASE:

Susan, an employee at SuperCo. cut her finger badly while on the job.  Susan reported the injury to her supervisor at work who, in turn, directed her to your practice to assess her injury.  Because of the acute nature of the injury, Susan travels over to your urgent care center for medical attention.

When Susan arrived at your front desk she described her injury and presented some of the FROI paperwork her employer had given her.  After you inserted her in for an appointment, you reviewed what she has provided you.  As it ends up, Susan didn’t have all her FROI information completed.   However, you jumped onto the BWC website and worked with Susan to complete her sections of the FROI so that a claim number (THINK BWC CLAIM--NOT MISYS CLAIM) could be issued.

You went to the BWC website, https://www.ohiobwc.com  and since you already had an account (If you don’t already have an account, YOU NEED TO GET ONE!), you logged in and hit the “Medical Providers” tab.

Below is the BWC screen for Medical Providers that will help you get the FROI completed.

The actual FROI can be found by going to the “Featured Links, File a claim” tab.  In that screen you’ll find all the information that needs to be completed from the employee, employer and you the medical provider.  Go to the bottom of the screen and you can complete, ONLINE, your portion (medical providers) of the FROI form.   

Once all of the required FROI fields are completed for the employee and medical provider, you can “submit” the claim and wait for the BWC to issue back your BWC claim number while online.  This number will be issued even if the employer has not yet completed their portion of the FROI.  While many practices fax their FROI’s over to the BWC to get a claim number, we recommend that you file your claims online because it is faster.  Claims can be submitted from the same “File a Claim” links and, once submitted, the claim number will be issued (often within 5 minutes) back to you online.

This claim number must be entered into the “CLAIM #” field in Misys in order to successfully submit the claim.  Claims will not be accepted without a BWC claim number.  In the rare circumstance that you are not able to obtain a BWC claim number online, you can enter the employee’s social security number in place of the claim number.  However, this will delay claims processing.

Additional Help for You!

Still Confused??  You can get additional help here at Alta – Contact Jennifer Negulescu, our BWC specialist – 440-808-3712.  Also, BWC hosts a “BWC University” if you would like to get training directly from the BWC University” enrollment dates and locations are announced on their website. 

Understanding The “Status” of the Employer to Enter into MISYS/Optimum

Once a claim number has been assigned, the next step is to enter the charge data into Misys/Optimum.  The one piece of critical information you need to know is if the employer uses an MCO to manage their workers compensation or if they are self-insured.  To determine the Employer's Workers' Compensation status, go back online and look them up.  This time, from the Medical Provider page use the “look-ups tab” – Employer/ MCO lookup.  From these screen you will find the following information:

Here’s an example of a self-insured employer

An example of a business that uses an MCO. – Note the differences.

TIP: Regardless of the employer address that Susan gave us, you need to use the address for the employer as listed in the BWC – Employer look-up table – that’s the address that is able to handle the claim.  

NOTE: There are a few self-insured employers who don’t use the BWC system to manage their claims.  If the employer is self-insured and you can’t find the employer online, have the patient provide you with employer contact information.

NOW, that we:

1. Know if the employer works with either an MCO or is self-insured and,
2. Know the claim number assigned to the injured worker,

you are ready to enter the data into Misys-Optimum.  The directions for entering information in the insurance block will differ depending on whether the employer uses an MCO or not.  Let’s start with a Self-Insured Employer:    
 

LOADING WORKERS COMPENSATION INFORMATION - SELF-INSURED EMPLOYER:

1.      Add "Responsible Relationship to Patient" as “11” when entering patient demographics.  This will ensure the correct insurance will default during charge entry.

2.      Add the Insurance and employer information to the appointment. This information will also default during charge entry. 

         For a self-insured employer the insurance block should be entered as follows: (see below for references to screen)

          a. "Insurance"  = WORK
          b. "Category"  = WORK
          c. "Plan"             = WORK

3.       The field "Claims To" should be "E" for employer.

4.       "Relationship To Insurance" will be a 1 or 2 for male/female subscriber.

5.       "Subscriber" will be the patient.

6.       "Subscriber's Employer" will be the Employer's Address -where we will send the claim per the FROI.  

7.       "SOCIAL SECURITY OR CASE #" – Use the employee SS# unless you have already obtained the Case #.

8.       "Address Y and Address N" will be entered as “1” – The Westlake, OH address.

9.       "Responsible Type" will be entered as “11”.   

LOADING WORKERS COMPENSATION INFORMATION – EMPLOYER USES AN MCO:

           Add "Responsible Relationship to Patient" as “11” when entering patient demographics.  This will ensure the correct insurance will default during charge entry.

1.           For an employer who uses an MCO, the insurance block should be entered as follows:

           a.  "Insurance"  = Code for MCO, i.e. MMCW (Careworks), BWGA (Gates McDonald, etc.)
           b.  "Category"  = WORK
           c.  "Plan"             = WORK

2.        "Claims To" should be "I" for insurance.

3.        "Relationship To Insurer" will be a 1 or 2 for male/female subscriber.

4.        "Subscriber" will be the patient.

5.        "Subs employer" - not necessary to fill in, but if you have it, add it.

6.        "Case #" will be the Case # given by the bureau.

           Note: if you haven’t yet received the case number, enter the employee’s SS#.

7.        "Address Y/N" will be the MCO's address.

8.        "Responsible Type" will be an 11

Again, if you have any questions, call Jennifer Negulescu at 440-808-3712 and she will be glad to help you out.