Self-Insured Programs in Ohio

Benefit Management Services of Ohio, Inc. has more than 34 years of experience administering workers’ compensation programs, and provides Ohio self-insured employers with comprehensive, results-oriented management of self-insured claims tailored to their specific needs. Our primary goal is to limit the client’s exposure to workers’ compensation claims.

Benefit Management Services of Ohio, Inc. services for self-insured employers feature flexible programs designed for each employer’s unique requirements and desired outcomes. Our experienced professionals manage all aspects of your program, allowing you to focus on your business.

We provide:

• Dedicated, tenured experts who aggressively manage claims on your behalf
• A team of account managers, claims examiners, hearing representatives and medical case specialists who work together to resolve claims and return employees to work
• Administrative functions, including preparation and submission of state reports, insurance certification and renewal
• On-site account visits and claim reviews, and preparation and attendance of BWC audits
• Integrated telephonic and case management programs
• Aggressive management of all litigated claims to help achieve the desired outcome and reduce financial exposure
• Online, high-level standard and ad hoc reporting accessible any day, anytime
• Aggressive pursuit of subrogation, settlements and recovery from third parties
• 1-800 and web-based claims reporting, twenty-four hours a day/365 days a year

Quality Service

Our services include quality control measures designed to ensure quick, accurate resolution of claims.

• Investigation is initiated on claims within twenty-four hours, using three point contact
• A diary is created on all active, litigated claims within two days of initial report
• All active and open claims are reviewed quarterly
• We ensure adjudication of medical fee bills within ten days, and a three day standard when establishing reserves
• Using our reporting web site, you can check current account stats and claims activity, and find up-to-date reports posted no later than the third business day of the month

Medical Cost Control

Benefit Management Services of Ohio, Inc.’s medical management program provides a structured framework for control of medical expenses while providing access to quality care. Services include:

• Aggressive fee bill adjudication services, including additional discounts offered through Provider Comp Network, one of the states largest provider networks
• Pharmacy benefit management program
• Copies of approved medical treatment plan issued to injured worker and physician, which helps control costs
• Prompt response to requests for prior authorization for medical treatments with expert review to ensure appropriate treatment
• Utilization review to make certain that all hospital stays and outpatient medical treatments are necessary

Self Insurance

An employer who meets required administrative and financial stability may be eligible to administer their workers’ compensation program as a self-insured employer. This option can result in substantial savings and greatly improved claim management. We can provide a financial analysis to determine if this option makes sense for your company.

Benefit Management Services of Ohio, Inc. offers self-insurance program administration services to Ohio employers. We provide state of the art technology, complete with aggressive claims management, to ensure our clients experience the highest quality, cost effective workers’ compensation program possible.

Our services include:

Claims Processing:

• Medical bill evaluation, including system generated fee schedule review
• Payment and EOB generation
• Compensation calculation and payment
• Form filing and distribution

Compliance Assistance

• Jurisdictional reporting compliance
• Pre audit and audit assistance
• OSHA / DOT program assistance
• Excess carrier reporting

Claims Management

• Lump sum settlement
• Independent medical examination
• Easy access claim management notes

Miscellaneous Services

• State of the art programming
• On-line services
• User friendly format

Client Education Services

• On site educational services for your supervisors

Loss Control and Safety Services

• Drug Free Work Place Program assistance
• Industry specific safety/loss control expertise

Applying Proven Strengths

Benefit Management Services of Ohio, Inc. claims management offers an extensive and diverse range of core services to meet the essence of measurable value results.

With the strength of thirty-four years of claims management experience, we offer centralized administration, heightened claims responsiveness, quality control programs, and consistent nationwide performance standards to ensure that your money, energy, and resources are spent wisely – no expended wastefully. We also do all that we can to make sure that every claim is settled fairly and quickly.

With our range of unbundled services, we will design for you a unique program honed precisely to your company’s needs and objectives. Each unique program we develop follows the same guidelines…. making sure we partner with you from start to finish to determine the most cost-effective plan for reducing your exposure and controlling potential losses.

Benefit Management Services of Ohio, Inc.’s strategic solution is to offer our clients the greatest degree of flexibility and choice in the self-insured programs and services we offer. We achieve this through a national network of exceptionally qualified managed care service providers, who work hand-in-hand and system-to-system with us to meet the following goal:

“Maximize both the quality of care provided and the effective use of workers compensation dollars to help employees and employers reduce the impact of injuries and illnesses by returning employees to productive work as quickly as possible”

No matter which options are selected, the following objectives always remain our priority:

• Control unit cost through healthcare provider contracts
• Maximize quality, while eliminating unnecessary medical services
• Ensure all medical charges are in accordance with state laws
• Track and record results and report them back to you

Containing Workers’ Compensation Costs

At Benefit Management Services of Ohio, Inc. we know that a strong claims management program demands strong management of medical treatment and healthcare resources in order to ensure high quality care for injured employees and to contain costs. To effectively maximize cost containment efforts, we design programs that enable you to exercise control over your workers’ compensation medical costs. We do this by providing you with the ability to handpick your individual services – making it easier for you to select, implement, and maintain the programs that work best for your overall risk management program.

Our service offerings include:

• PPO Hospital, Outpatient Care, & Retail Pharmaceutical Networks
• Wholesale Prescriptions & Medical Equipment Programs
• Medical Case Management & Vocational Rehabilitation Services
• Usual, Customary & Reasonable Bill Review Services
• State Fee Scheduling
• Hospital Bill Audits
• Utilization Review & Injury Management Programs

Benefit Management Services of Ohio, Inc.
CONTROLLING WORKERS' COMPENSATION CLAIMS

The payment of Workers’ Compensation premiums threatens the livelihood of many businesses throughout the nation. State fund deficits and legal changes have escalated these premiums from $23 billion in 1982 to more than $60 billion in 1990. Unlike regular health-care costs, every employer is required to pick up the tab.

Changes That Have Impacted Workers’ Compensation
Three major changes occurred in Workers’ Compensation in the 1980’s that transformed a sleepy legislative no-fault benefit program into the volatile cost component it is today.

First, programs to control healthcare costs for injuries and illnesses outside the workplace – e.g., deductible, co-payments, HMO utilization review – had the effect of “cost shifting” these medical costs into the Workers’ Compensation arena, where the employer is responsible for every dollar paid.

Second, the original no-fault intent of Workers’ Compensation laws has given way to judicial interpretations that have produced a system strangled by litigation. In California, 44% of all Workers’ Compensation cases involving lost time end up in a lawsuit.

Third, the nature of workplace injuries and illnesses is shifting dramatically, with an increasing incidence of so-called cumulative trauma injuries and those associated with repetitive motion. The latest is the development of psychological and mental stress claims.

Most companies are not set up to react to, let alone manage, the problem. Benefit Management Services of Ohio, Inc. provides comprehensive and professional management of your Workers’ Compensation program across the entire spectrum of Workers’ Compensation services from state-funded accounts to group rated programs to self-insured companies. Through a refined and rigorous process for claims administration, we are able to assist our clients seeking admission to a group rated program or those working to remain enrolled.

From loss and claims prevention, to litigation of the claim, Benefit Management Services of Ohio, Inc. becomes an integral part of your senior management team, helping you to:

• Understand your current programs
• Get the facts on workers’ compensation claims
• Build a cost-containment program that involves line management, your vendors and medical providers
• Track frequency and severity of workers’ compensation claims
• Through education and training, help inform employees and managers of ways to control workers’ compensation costs
• Instruct designated people in your company about the rules and regulations of your Workers’ Compensation Bureau
• Survey and record your rating and make application to correct errors
• Review, process and record each claim
• Challenge all suspect claims
• Attend all hearings
• Provide detailed and informative monthly loss runs
• Conduct quarterly site inspections and establish a Loss Prevention Program that “makes a difference”
• Employer contact and Return to Work assessment
• Medical monitoring
• Light-duty assessment

This comprehensive program of Workers’ Compensation management will ultimately result in a reduction of premium rates.