4123-6-02.6 Provider access to the HPP - selection by an MCO.

 

 

 

4123-6-02.6                 Provider access to the HPP -- selection by an MCO.

 

 

 

(A)  The bureau shall maintain a public list of bureau certified providers. The bureau shall make the list of bureau certified providers available to a requesting party at cost via the bureau's internet site.

 

(B)    An MCO may, but is not required to, retain a panel of bureau-certified bureau certified providers. A bureau certified provider is eligible for selection by an MCO 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 one MCO panel.

 

(C)   A provider identified by an MCO for temporary privileges in its panel of providers that is not a bureau certified provider shall be assisted by the MCO in applying for bureau provider credentialing and certification.

 

(D)    The bureau or MCO shall not discriminate against any category of health care provider when establishing categories of providers for participation in the HPP. However, neither the bureau nor an MCO is required to accept or retain any individual provider in the HPP.

 

(E)   The MCO shall include in its panel or its arrangements with providers a substantial number of the medical, professional, and pharmacy providers currently being utilized by employees. An MCO may limit the number of providers on its MCO provider panel or with whom they enter into arrangements, but must do so based upon objective data approved by the bureau, such as reasonable patient access, community needs, the potential number of employees the MCO is applying to service, and other performance criteria, without discrimination by provider type.

 

(F)    A bureau certified provider must submit to follow the medical management and return to work management approaches of the employee's employer's MCO medically managing an employee's claim, as provided in rule 4123-6-04.2 of the Administrative Code, whether or not the provider is, or is not, on the MCO's provider panel, or has an arrangement with the MCO.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4123-6-02.6                                                                                                                           2

Effective:                                                     03/05/2010

R.C. 119.032 review dates:                         11/17/2009 and 02/01/2015

CERTIFIED ELECTRONICALLY

Certification

02/23/2010

Date

Promulgated Under:                           119.03

Statutory Authority:                           4121.12, 4121.121, 4121.30, 4121.31, 4123.05

Rule Amplifies:                                  4121.121, 4121.44, 4121.441, 4123.66

Prior Effective Dates:                         2/16/96, 1/1/01