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Penalty and Interest

Last update
March 15, 2019

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

MCO Policy Reference Guide copyright page  

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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