An additional penalty of $10 should be included on overdue balances for workers' compensation medical bills in Ohio when incorrectly denied for lack of authorization.
State |
Ohio |
Late Payment Due Date |
7 days for MCO to send to State 30 days for State to process 7 days for MCO to pay after funds received from State |
Late Payment Percentage |
Penalty: $10.00 when denied for lack of authorization when authorization was granted or not required |
MCO Policy Manual |
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Statute or Regulation Text |
MCO Policy Manual, Chapter 8 page 8-29
14. Penalty payment MCOs are required to pay a penalty of ten dollars ($10.00) to the provider for every instance in which the MCO denies a provider’s bill due to lack of prior authorization and prior authorization either had been granted or was not required per standardized prior authorization and/or presumptive authorization guidelines table found in Chapter 1 of the Provider Billing and Reimbursement Manual on the date of service. The MCO is not required to make a penalty payment when a bill is inappropriately denied due to lack of prior authorization for retroactive medical service requests. Penalty payments shall be paid from funds appropriated by the MCO and not from its provider bank account. The MCO shall issue payment to the provider within 14 calendar days upon discovery or notification of the inappropriate prior authorization denial. The MCO shall email BWC’s HPP Inquiry Unit with the date and to whom the penalty payment was issued.
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