Ohio Administrative Code Search

...ontainment services shall not require a provider to participate in a workers' compensation network of providers in order to maintain membership in a related health care program. If the QHP utilizes a leased provider network, the QHP shall not apply the discounted payment rates of the leased network to services rendered by the provider in the QHP unless the signed, written consent of the provider has been obtained.

...ement standards of credentialing of providers in the QHP network that meet but may exceed the bureau credentialing requirements in the HPP. (B) An employer that develops a QHP may selectively contract with providers or contract with a vendor that selectively contracts with providers. (C) Only a bureau certified provider is eligible for selection by an employer that develops a QHP, by a QHP as a ...

... and an employer, an employee and a provider, or an employer and a provider. This rule applies to, but is not limited to, reviews of records, medical disputes arising over issues such as, but not limited to, quality assurance, utilization review, a determination that a service provided to an employee is not covered, is covered or is medically unnecessary; or disputes involving individual health ...

... and his or her representative, and the provider. All parties providing or requiring such confidential information for use in the QHP system shall not provide or use such confidential information for any purpose other than to perform duties required under the QHP system, and shall prevent such information from further disclosure or use by unauthorized persons.

...'s disability evaluators' panel and provider certification. All "proceedings and records within the scope of a peer review committee of a health care entity." See division (E)(2)(j) of section 2305.25 of the Revised Code and section 2305.252 of the Revised Code. (G) Governmental records that are exempt from disclosure under the public records act. See section 149.43 of the Revised Code. (H) ...

...nsitional work developer" means the provider who develops the employer's transitional work program. A transitional work developer shall: (a) Meet the minimum credentials designated in rule 4123-6-02.2 of the Administrative Code for one of the following provider types: (i) A vocational rehabilitation case manager, (ii) An occupational therapist, or (iii) A physical therapist; and ...

...nsitional work developer" means the provider who develops the employer's transitional work program. A transitional work developer shall: (a) Meet the minimum credentials designated in rule 4123-6-02.2 of the Administrative Code for one of the following provider types: (i) A vocational rehabilitation case manager, (ii) An occupational therapist, or (iii) A physical therapist; and ...

...nsitional work developer" means the provider who develops the employer's transitional work program. A transitional work developer shall: (a) Meet the minimum credentials designated in rule 4123-6-02.2 of the Administrative Code for one of the following provider types: (i) A vocational rehabilitation case manager, (ii) An occupational therapist, or (iii) A physical therapist; and ...

...ect to pay to the injured worker or the provider on behalf of the injured worker the first fifteen thousand dollars of a medical-only claim. Employers may elect which medical-only claims they do not wish to cover under this program. (1) An employer electing to pay bills in its employees' medical-only claims is responsible for all bills in a claim until the fifteen thousand dollar maximum is reached and the employer ...

...o pay to the injured worker, or the provider on behalf of the injured worker, the first fifteen thousand dollars of a medical-only claim. Employers may elect which medical-only claims they do not wish to cover under this program. (1) An employer electing to pay bills in its employees' medical-only claims is responsible for all bills in a claim until the fifteen thousand dollar maximum is reac...

...akes direct payments to any medical provider for services rendered or supplies or to any injured worker for compensation associated with a workers' compensation claim. (4) The employer engages in misrepresentation or fraud in conjunction with the deductible program application process. (N) An employer removed from the deductible program for failure to comply with paragraph (B) of this rule w...

...akes direct payments to any medical provider for services rendered, to any medical provider for supplies or to any injured worker for compensation associated with a workers' compensation claim; (4) The employer engages in misrepresentation or fraud in conjunction with the deductible program application process; or (5) The employer fails to report actual payroll for the preceding policy year ...

...er makes direct payments to any medical provider for services rendered, to any medical provider for supplies or to any injured worker for compensation associated with a workers' compensation claim; (4) The employer engages in misrepresentation or fraud in conjunction with the deductible program application process; or (5) The employer fails to report actual payroll for the preceding policy year or fails to pay any ...

...akes direct payments to any medical provider for services rendered, to any medical provider for supplies or to any injured worker for compensation associated with a workers' compensation claim; (4) The employer engages in misrepresentation or fraud in conjunction with the deductible program application process; or (5) The employer fails to report actual payroll for the preceding policy year ...

...akes direct payments to any medical provider for services rendered, to any medical provider for supplies or to any injured worker for compensation associated with a workers' compensation claim; (4) The employer engages in misrepresentation or fraud in conjunction with the deductible program application process; or (5) The employer fails to report actual payroll for the preceding policy year ...

...cational rehabilitation case management provider contacts the injured worker and prepares a written vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan for the injured worker's acknowledgment and approval. The vocational rehabilitation case management provider will, where practical, consult with the injured worker's employer, the physician of record, and othe...

...onal rehabilitation case management provider contacts the injured worker and prepares a written vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan for the injured worker's acknowledgment and approval. The vocational rehabilitation case management provider shall, where practical, consult with the injured worker's employer, the physicia...

...cational rehabilitation case management provider contacts the injured worker and prepares a written vocational rehabilitation assessment plan, comprehensive vocational rehabilitation plan, or job retention plan for the injured worker's acknowledgment and approval. The vocational rehabilitation case management provider will, where practical, consult with the injured worker's employer, the physician...

... adopts the vocational rehabilitation provider fee schedule indicated in appendix A to this rule, developed with stakeholder input, effective October 1, 2020. (B) Notwithstanding the provisions of paragraph (A) of this rule, consistent with the provisions of division (F)(1) of section 4121.44 of the Revised Code, managed care organizations may enter into other arrangements and reimbursement agr...

... adopts the vocational rehabilitation provider fee schedule indicated in appendix A to this rule, developed with stakeholder input. (B) Notwithstanding the provisions of paragraph (A) of this rule, consistent with the provisions of division (F)(1) of section 4121.44 of the Revised Code, managed care organizations may enter into other arrangements and reimbursement agreements with medical, professio...

... adopts the vocational rehabilitation provider fee schedule indicated in appendix A to this rule, developed with stakeholder input, effective October 1, 2021. (B) Notwithstanding the provisions of paragraph (A) of this rule, consistent with the provisions of division (F)(1) of section 4121.44 of the Revised Code, managed care organizations may enter into other arrangements and reimbursement agr...

...by adopts the vocational rehabilitation provider fee schedule indicated in the appendix to this rule, developed with stakeholder input. (B) Notwithstanding paragraph (A) of this rule, consistent with division (F)(1) of section 4121.44 of the Revised Code, managed care organizations may enter into other arrangements and reimbursement agreements with medical, professional, and pharmacy providers.

...dopts the vocational rehabilitation provider fee schedule indicated in the appendix to this rule, developed with stakeholder input. (B) Notwithstanding paragraph (A) of this rule, consistent with division (F)(1) of section 4121.44 of the Revised Code, managed care organizations may enter into other arrangements and reimbursement agreements with medical, professional, and pharmacy providers.

...y the MCOs, utilizing the services of a provider who meets the minimum credentialing criteria set forth in rule 4123-6-02.2 of the Administrative Code. The self-insuring employer will submit a copy of the approved vocational rehabilitation plan to the injured worker and the injured worker's representative. (C) The bureau will inspect and review the quality and content of all authorized self-insuring employers' vocat...

...y the MCOs, utilizing the services of a provider who meets the minimum credentialing criteria set forth in rule 4123-6-02.2 of the Administrative Code. The self-insuring employer shall submit a copy of the approved vocational rehabilitation plan to the injured worker and the injured worker's representative. (C) The bureau shall inspect and review the quality and content of all authorized self-ins...