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VOHP Medical Managed Care and Case Management Services
  

• Medical Cost Management

• Nurse Case Management

• Disability Management

• Ohio Managed Care Organization (MCO)

• URAC Accredited

   
     
 
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Understanding the Roles & Responsibilities of your Managed Care Organization (MCO)

How did VOHP become my MCO?

Every employer that obtains workers’ compensation insurance through the Ohio BWC is assigned or selects an MCO. If an employer does not select an MCO within 90 days of establishing workers’ compensation coverage or before they have their first claim, an MCO is assigned to them.

How does VOHP get paid to provide these services?

VOHP is paid by the Ohio BWC a percentage of each assigned employers’ premiums to medically manage their claims. VOHP is not paid directly by the employer.

What is the difference between an MCO and a TPA (Third Party Administrator)?

Every Ohio employer is required to have an MCO who is paid by the BWC to medically manage claims. The BWC closely governs the performance and services of the MCO, whereas, a TPA is an optional third party claims management organization that is available to employers on a fee basis. TPAs work as the authorized agent for the employer and have a broader risk management scope than an MCO has in medical claims management.

TPAs will assist employers in certifying/rejecting claims, help determine the premium impact of a claim, enroll an employer in a Group Rating program, attend hearings on the employer’s behalf, and perform many other services that are not related to medically managing claims.

• Get Answers to Commonly asked Employer MCO Questions (View Full Version Here)

 
   

Vantage Occupational Health Plan specializes in working closely with employers to develop an integrated strategy for managing claims and controlling Workers' Compensation costs. Our employers come from many different industries including heavy manufacturing to small businesses to public entities, and everything in between.

In the world of workers' compensation, bigger is not better. This is true with claims and especially with MCOs. Now, more than ever, employers need hands-on, personalized service when it comes to dealing with Workers' Compensation.

Since 1999, Vantage has built a reputation as an MCO that successfully manages high-risk employers of all types who have complex and unique challenges.

    

As an Employer
You know the people on the frontlines of your business have a trememdous impact on the success of your company. At Vantage, we feel the same way about our claims team. Your Claims Manager and Nurse Case Manager work from day one of an injury to ensure a successful resolution to your specific situation.

Preferred Medical Provider Partnership
Preferred Medical Providers play a key role in the successful resolution of any workers' compensation claim. Vantage has an extensive history in working with providers to help employers achieve positive outcomes.

Knowledge is Power
That's why Vantage offers detailed and customized medical bill payment and case management reports to help you stay abreast of cost factors impacting your Workers' Compensation premium. Vantage also offers comprehensive Risk Management training and education for you and your employees. In most cases, your dedicated claims management team provides this training, the ones who know you and your claims the best.

Proactive Case Management
Upon notification of a claim, Vantage's team of experienced claims managers go to work coordinating information between the employer, the injured worker, and the local treating provider to help return the injured worker back to work in a timely and safe manner.

Service + Plus +
Through our parent company, Occupational Health Plan (OHP), you have access to a wide range of ancillary services designed to help reduce your risk and control your Workers' Compensation costs. Programs such as Disability Management, OHIO Premium Discount Program, and Vocational Rehabilitation Case Management are just a few of the many services available to you as a Vantage employer.

   
   
 
© 2008 Occupational Health Plan, Inc.