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Rules
Rule
Rule 4123-6-02.2 | Provider access to the HPP - provider certification criteria.

...eau will establish minimum criteria for provider certification. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified, or accredited pursuant to the equivalent law of another state qualifies as a provider under this rule in that state. However, a provider is ineligible to participate in the health partn...
Rule 4123-6-02.2 | Provider access to the HPP - provider certification criteria.

...eau will establish minimum criteria for provider certification. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified, or accredited pursuant to the equivalent law of another state qualifies as a provider under this rule in that state. However, a provider is ineligible to participate in the health partnership program if: ...
Rule 4123-6-02.3 | Provider access to the HPP - provider application and certification criteria.

...bureau shall make available to each provider a provider certification application and agreement or recertification application and agreement, as applicable, which shall require the provider to furnish documentation as provided in rule 4123-6-02.2 of the Administrative Code. (B) The provider application and agreement or recertification application and agreement shall require the provider to ma...
Rule 4123-6-02.3 | Provider access to the HPP - provider application and certification criteria.

...The bureau shall make available to each provider a provider certification application and agreement or recertification application and agreement, as applicable, which shall require the provider to furnish documentation as provided in rule 4123-6-02.2 of the Administrative Code. (B) The provider application and agreement or recertification application and agreement shall require the provider to make statements that t...
Rule 4123-6-02.4 | Provider access to the HPP - provider recertification.

...tification process by sending certified providers notice and a recertification application and agreement, which must be completed, signed and submitted to the bureau if the provider wishes to be considered for recertification. (B) Except as otherwise provided in paragraph (E) of this rule, if the bureau receives a completed and signed recertification application and agreement from a provider, the...
Rule 4123-6-02.4 | Provider access to the HPP - provider recertification.

...tification process by sending certified providers notice and a recertification application and agreement, which must be completed, signed, and submitted to the bureau if the provider wishes to be considered for recertification. (B) Except as otherwise provided in paragraph (E) of this rule, if the bureau receives a completed and signed recertification application and agreement from a provider, the provider's certifi...
Rule 4123-6-02.5 | Provider access to the HPP - provider not certified.

...(A) A provider not certified or recertified shall cure any defects in the provider application and agreement or recertification application and agreement within thirty days of notice by the bureau. (B) The administrator of the bureau of workers' compensation, pursuant to rule 4123-6-17 of the Administrative Code, may refuse to certify or recertify or may decertify a provider where the provider ha...
Rule 4123-6-02.5 | Provider access to the HPP - provider not certified.

...(A) A provider not certified or recertified shall submit any information missing from the provider application and agreement or recertification application and agreement upon request, within thirty days of notice by the bureau. The bureau may deny certification or recertification if the provider fails to submit the requested information. (B) The administrator of the bureau of workers' compensation, pursuant to rule...
Rule 4123-6-02.6 | Provider access to the HPP -- selection by an MCO.

...n a public list of bureau certified providers. The bureau shall make the list of bureau certified providers available through the bureau's website. (B) An MCO may, but is not required to, retain a panel of bureau certified providers. A bureau certified provider is eligible to participate on an MCO's provider panel. A bureau certified provider may participate in a single MCO panel or may participa...
Rule 4123-6-02.6 | Provider access to the HPP -- selection by an MCO.

...ntain a public list of bureau certified providers. The bureau shall make the list of bureau certified providers available through the bureau's website. (B) An MCO may, but is not required to, retain a panel of bureau certified providers. A bureau certified provider is eligible to participate on an MCO's provider panel. A bureau certified provider may participate in a single MCO panel or may participate in more than ...
Rule 4123-6-02.7 | Provider access to the HPP - provider decertification procedures.

...ollment of and decertify a non-facility provider who has failed to comply with a workers' 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 sha...
Rule 4123-6-02.7 | Provider access to the HPP - provider decertification procedures.

...ollment of and decertify a non-facility provider who has failed to comply with a workers' 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 wil...
Rule 4123-6-02.7 | Provider access to the HPP - provider decertification procedures.

...ollment of and decertify a non-facility provider who has failed to comply with a workers' 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 wil...
Rule 4123-6-02.8 | Provider requirement to notify of injury.

...r initial visit of an injured worker, a provider must report the employee's injury or occupational disease in accordance 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 bu...
Rule 4123-6-02.9 | Provider access to the HPP - provider marketing.

...(A) No bureau certified or enrolled provider shall engage in any advertising or solicitation directed to injured workers which is false, fraudulent, deceptive, or misleading. (B) No bureau certified or enrolled provider shall hire, arrange for, or allow any other individual or entity to engage in any advertising or solicitation directed to injured workers on behalf of the provider which is false,...
Rule 4123-6-02.21 | Provider access to the HPP - non-certified provider enrollment.

...The bureau may enroll non-certified providers eligible under rule 4123-6-06.2 or 4123-6-10 of the Administrative Code or division (N) of section 4121.44 of the Revised Code to receive reimbursement for goods and services provided to injured workers, and for this purpose may require such non-certified providers to complete and sign an enrollment application as the bureau deems appropriate, provided...
Rule 4123-6-02.21 | Provider access to the HPP - non-certified provider enrollment.

...(A) The bureau may enroll non-certified providers eligible under rule 4123-6-06.2 or 4123-6-10 of the Administrative Code or division (N) of section 4121.44 of the Revised Code to receive reimbursement for goods and services provided to injured workers, and for this purpose may require such non-certified providers to complete and sign an enrollment application as the bureau deems appropriate, provided such non-certif...
Rule 4123-6-02.22 | Provider access to the HPP - ambulatory surgical center arthroplasty center requirements.

...(A) To be eligible for participation in the HPP as an ambulatory surgical center arthroplasty center, an ambulatory surgical center must comply with the following minimum criteria: (1) The facility must be bureau certified as an ambulatory surgical center under paragraph (C) of rule 4123-6-02.2 of the Administrative Code. (2) The facility must have a formal joint replacement program which has be...
Rule 4123-6-02.22 | Provider access to the HPP - ambulatory surgical center arthroplasty center requirements.

...(A) To be eligible for participation in the HPP as an ambulatory surgical center arthroplasty center, an ambulatory surgical center must: (1) Be certified as an ambulatory surgical center under paragraph (C) of rule 4123-6-02.2 of the Administrative Code. (2) Have a formal joint replacement program which has been in place for at least one year prior to the date of application, and have perfo...
Rule 4123-6-02.51 | Provider access to the HPP -- Denial of provider, entity or MCO enrollment or certification based on criminal conviction or civil action.

... from participation in the HPP, any provider or entity that: (1) Is owned, directly or indirectly, by an individual or entity that has been convicted of or pleaded guilty to a criminal offense as set forth in the appendix to rule 4123-6-02.2 of the Administrative Code. The provider or entity is ineligible for enrollment, certification, or recertification for the same period of ineligibility p...
Rule 4123-6-02.51 | Provider access to the HPP -- Denial of provider, entity or MCO enrollment or certification based on criminal conviction or civil action.

...tify from participation in the HPP, any provider or entity that: (1) Is owned, directly or indirectly, by an individual or entity that has been convicted of or pleaded guilty to a criminal offense as set forth in the appendix to rule 4123-6-02.2 of the Administrative Code. The provider or entity is ineligible for enrollment, certification, or recertification for the same period of ineligibility provided in the appen...
Rule 4123-6-03.2 | MCO participation in the HPP -- MCO application for certification or recertification.

...hall include a list of bureau certified providers in its provider panel and/or bureau certified providers with which the managed care organization has arrangements. (C) The MCO application submitted to the bureau by the managed care organization shall include the following, whether the managed care organization elects to retain a provider panel or enters into provider arrangements: (1) A description of the managed ...
Rule 4123-6-03.2 | MCO participation in the HPP -- MCO application for certification or recertification.

...hall include a list of bureau certified providers in its provider panel and/or bureau certified providers with which the MCO has arrangements. (C) Regardless of whether the MCO elects to retain a provider panel or enters into provider arrangements, the application submitted to the bureau by the MCO shall include the following: (1) A description of the MCO's health care provider panel or prov...
Rule 4123-6-03.7 | MCO participation in the HPP - bureau's authority to decertify, to refuse to certify or recertify an MCO.

...o recertify an MCO, any obligation of a provider to provide services under the HPP pursuant to a contract or agreement with such MCO shall be null and void.
Rule 4123-6-03.7 | MCO participation in the HPP - bureau's authority to decertify, to refuse to certify or recertify an MCO.

...o recertify an MCO, any obligation of a provider to provide services under the HPP pursuant to a contract or agreement with such MCO shall be null and void.