This information can be obtained by directly contacting the BWC or the MCO. The annual on-site audit by the BWC has five elements that are essential in gauging an MCO's performance, based on contractual and procedural compliance with the MCO BWC contract and policy reference guide:

"¢ Financial processes
"¢ Billing processes
"¢ Case management processes
"¢ Vocational rehabilitation reviews
"¢ Retrospective bill reviews

"It would not be in an employers' best interest to consider selecting an MCO that did not achieve a minimum compliance of 90% or greater" BWC audit score, says Joe Mercurio, director of operations for Avatar COMP. "An employer needs to be aware of any instances where their current MCO was placed 'at capacity'."
The BWC will place an MCO "at capacity" for a variety of reasons, including:

"¢ Failure to comply with their contractual obligations (failing the audit two consecutive years.)
"¢ Failure to comply with the MCO-BWC policy reference guide.
"¢ Failure to meet BWC specified benchmarks pertaining to billing, claims, processing, provider account reconciliation, and appropriate use of the State and Surplus Fund for claims in vocational rehabilitation.
"¢ Fraud.
"¢ Marketing violations.
"¢ Firewall violations as defined by OAC 4123-6-039.