Ohio Administrative Code Search

...tablished in paragraph (C) of rule 4123-3-09 of the Administrative Code. (E) Except in matters not affecting the rights of the opposite party, the applicant filing a motion shall provide a copy of the motion to the opposite party and the copy of the motion filed with the bureau or the commission shall indicate that a copy has been so provided. When in doubt, the applicant shall provide a copy of...

...tablished in paragraph (C) of rule 4123-3-09 of the Administrative Code. (E) Except in matters not affecting the rights of the opposite party, the applicant filing a motion shall provide a copy of the motion to the opposite party and the copy of the motion filed with the bureau or the commission shall indicate that a copy has been so provided. When in doubt, the applicant shall provide a copy of...

...(A) Administrative appeals. (1) The right of an administrative appeal is limited to the claimant, the dependents of a deceased worker, the employer, and the administrator, where the administrator or the administrator's representative appeals on behalf of the state insurance fund and/or the surplus fund. (2) The named eligible appellants may appeal decisions of the district hearing officers, or s...

...(A) Administrative appeals. (1) The right of an administrative appeal is limited to the claimant, the dependents of a deceased worker, the employer, and the administrator, where the administrator or the administrator's representative appeals on behalf of the state insurance fund and/or the surplus fund. (2) The named eligible appellants may appeal decisions of the district hearing officers, or staff hearing officer...

...(A) Administrative appeals. (1) The right of an administrative appeal is limited to the claimant, the dependents of a deceased worker, the employer, and the administrator, where the administrator or the administrator's representative appeals on behalf of the state insurance fund or the surplus fund. (2) The named eligible appellants may appeal decisions of district hearing officers or staff hear...

...ndicap reimbursement under section 4123.343 of the Revised Code, a "handicapped employee" means an employee who is defined as having one or more of the conditions listed in division (A) of section 4123.343 of the Revised Code. (1) With respect to the handicap condition defined in division (A)(4) of section 4123.343 of the Revised Code, degenerative disc disease, spondylosis, spondylolysis, an...

...of disability relief under section 4123.343 of the Revised Code, an "employee with a disability" means an employee who is defined as having one or more of the conditions listed in division (A) of section 4123.343 of the Revised Code. (1) With respect to the condition defined in division (A)(4) of section 4123.343 of the Revised Code, degenerative disc disease, spondylosis, spondylolysis, and ...

...(A) Pursuant to section 4123.932 of the Revised Code and when an employer satisfies all of the requirements of this rule, the bureau shall charge to the surplus fund created under division (B) of section 4123.34 of the Revised Code any compensation and benefits related to a compensable workers' compensation claim based on a motor vehicle accident involving a third party. This rule applies only to ...

...(A) Pursuant to section 4123.932 of the Revised Code and when an employer satisfies all of the requirements of this rule, the bureau shall charge to the surplus fund created under division (B) of section 4123.34 of the Revised Code any compensation and benefits related to a compensable workers' compensation claim based on a motor vehicle accident involving a third party. This rule applies only to ...

... (E) of this rule and paragraph (B)(1)(b) of rule 4123-3-09 of the Administrative Code, no payment of compensation shall be approved by the bureau of workers' compensation in a claim unless supported by a report of a physician duly licensed to render the treatment. (B) When evaluating the sufficiency of medical proof, the following criteria shall be considered: (1) The nature and type of in...

... (E) of this rule and paragraph (B)(1)(b) of rule 4123-3-09 of the Administrative Code, no payment of compensation shall be approved by the bureau of workers' compensation in a claim unless supported by a report of a physician duly licensed to render the treatment. (B) When evaluating the sufficiency of medical proof, the following criteria shall be considered: (1) The nature and type of in...

...rior to filing an appeal under section 4123.511 of the Revised Code. (F) "Emergency" means: Medical services that are required for the immediate diagnosis and treatment of a condition that, if not immediately diagnosed and treated, could lead to serious physical or mental disability or death, or that are immediately necessary to alleviate severe pain. Emergency treatment includes treatment deli...

...he health partnership program if: (1) The state of Ohio has denied the provider's application for a professional license or the provider's professional license in Ohio is under revocation or suspension; or (2) The provider's professional license is subject to disciplinary restrictions that affect the provider's ability to treat patients or that compromise patient care. (B) The minimum c...

...he health partnership program if: (1) The state of Ohio has denied the provider's application for a professional license or the provider's professional license in Ohio is under revocation or suspension; or (2) The provider's professional license is subject to disciplinary restrictions that affect the provider's ability to treat patients or that compromise patient care. (B) The minimum c...

...orkers' compensation statute or rule. (1) If the bureau determines a provider has committed three or more reported violations of the same workers' compensation statute or rule in a six month period, or five or more reported violations of any workers' compensation statute or rule in a six month period, the bureau shall send the provider written notification of the violations by certified mail. (2...

...orkers' compensation statute or rule. (1) If the bureau determines a provider has committed three or more reported violations of the same workers' compensation statute or rule in a six month period, or five or more reported violations of any workers' compensation statute or rule in a six month period, the bureau will serve written notice of the violations to the provider. (2) If the bureau d...

...ccordance with either paragraph (A)(1) or (A)(2) of this rule. (1) A provider may report an injury to the MCO responsible for medical management of the employee's treatment. When reporting the injury to the MCO, the provider shall do so in accordance with procedures established by the bureau. (2) A provider may report an injury to the bureau through the bureau's website pursuant to rule 4125-1-0...

...ipation in the HPP, any MCO that: (1) Is owned, directly or indirectly, by an individual or entity that has a felony conviction in any jurisdiction, a conviction under a federal controlled substance act, a misdemeanor conviction for an act involving dishonesty, fraud, or misrepresentation, a conviction for a misdemeanor committed in the course of practice, or a felony or misdemeanor convictio...

...or enters into provider arrangements: (1) A description of the managed care organization's health care provider panel or provider arrangements, which shall include a substantial number of the medical, health care professional and pharmacy providers currently being utilized by injured workers. The provider panel or provider arrangements shall cover the geographic area in which the managed care organization determines...

... MCO shall include the following: (1) A description of the MCO's health care provider panel or provider arrangements, including a substantial number of the medical, health care professional and pharmacy providers currently being utilized by injured workers. The provider panel or provider arrangements shall cover the geographic area in which the MCO plans to compete, and may include out-of-sta...

...(A) Pursuant to division (A)(1)(h) of section 4121.441 of the Revised Code, the administrator of workers' compensation, with the advice and consent of the bureau of workers' compensation board of directors, develops, maintains, and publishes a provider fee schedule for the various types of billing codes. The administrator hereby adopts the professional provider fee schedule indicated in the append...

...(A) Pursuant to division (A)(1)(h) of section 4121.441 of the Revised Code, the administrator of workers' compensation, with the advice and consent of the bureau of workers' compensation board of directors, develops, maintains, and publishes a provider fee schedule for the various types of billing codes. The administrator hereby adopts the professional provider fee schedule indicated in the append...

... from the MCO pursuant to paragraph (A)(1) of rule 4123-6-10 of the Administrative Code for payment eligibility. The bureau's review may include, but not be limited to, verification of the following: (1) The services were delivered, rendered, or directly supervised by providers who meet bureau credentialing and licensing criteria; (2) The bills conform to the bureau's billing and reimbursement m...

...op electronic billings to the bureau. (1) The MCO shall retain records relating to a claim so long as the industrial commission and bureau of workers' compensation have continuing jurisdiction over the claim pursuant to section 4123.52 of the Revised Code. (2) The MCO shall also create, maintain, and retain records documenting transactions with the injured worker, providers, and subcontractors ...

...(A) Pursuant to division (A)(1) of section 4121.441 of the Revised Code, this rule shall provide procedures for an alternative dispute resolution (ADR) process for medical disputes between an employer, an injured worker, or a provider and an MCO arising from the MCO's decision regarding a medical treatment reimbursement request (on form C-9 or equivalent). An injured worker or employer must exhaus...