Managed Care Organizations must pay undisputed workers’ compensation bills within 7 days of receiving funds from the state, which has 30 days to process those bills submitted within 7 days of services rendered.
State |
Ohio |
Timely Payment |
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 |
Ohio Administrative Code |
Ohio Administrative Code » 4123 Bureau of Workers' Compensation |
Rule |
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Rule Text |
4123-6-10 Payment to providers. (A)(1) The MCO shall accumulate medical records and bills for services rendered to employees for provider services and submit the bills electronically to the bureau for payment in a bureau approved format, utilizing billing policies, including but not limited to clinical editing, as set forth in the MCO contract. The MCO shall submit a bill to the bureau within seven business days of its receipt of a valid, complete bill from the provider. 4123-6-14 MCO bill submission to bureau. (2) The bills conform to standard clinical editing criteria in effect on the billed date(s) of service, including but not limited to: the bureau's billing and reimbursement manual, the centers for medicare and medicaid services' healthcare common procedure coding system (HCPCS), and the national correct coding initiative (NCCI) guidelines.
The bureau shall electronically transfer funds to the MCO for allowed payments after receipt of a proper invoice and after a final adjudication permitting payment for the bill. Upon receipt of funds from the bureau, the MCO shall pay the provider within seven days or less. The MCO shall pay to providers at least the amount electronically transferred by the bureau to the MCO for reimbursement of provider services. State has 30 days to process the bills.
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