Ohio’s Managed Care Organizations — the private companies that manage the medical side of every state-fund claim, authorise your services and pay your bills. Nine of them, and only in Ohio.
Ohio is a monopolistic state: employers buy coverage from the Bureau of Workers’ Compensation. Under the Health Partnership Program, every state-fund employer also picks a private Managed Care Organization, which manages the medical and return-to-work side of its employees’ claims — approving treatment, coordinating return to work, reviewing bills and paying providers.
Nine are currently certified: CorVel (CorVel Ohio), MinuteMen (OhioComp), OHL (Occupational Health Link), 3-hab, Ltd., AultComp, ProMedica (formerly HMS), Spooner MAI, Sedgwick MCO, Sheakley UniComp.
This intermediary exists nowhere else in the country. Some of the parent companies do — Sedgwick and CorVel are national TPAs — but the MCO role itself is Ohio-only.
The claim in front of you carries an MCO, chosen by the employer, and that is who authorises your services and pays your bill. Get the wrong one and the bill goes nowhere.
In practice a book concentrates. In our first customer’s anonymised week, three MCOs carried roughly 65%, 19% and 15% of billings — which is why one check covering many claimants is the defining Ohio receivables problem.
Phone and fax for all nine are on the Ohio MCO directory, and the Ohio billing guide covers authorisation and the fax channel.
Fifteen minutes, your state’s codes on screen — or start the trial and poke around on your own.