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FAQ
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How did Avatar Comp become my Managed Care
Organization (MCO)?
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What should I expect from Avatar Comp?
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Why did the Bureau assign a MCO, I did not
select Avatar Comp, nor do I have any claims?
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Why hasn't Avatar Comp contacted my company?
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What if I want a meeting with Avatar Comp
(on-site or off-site) to discuss
my claims or arrange for specific training?
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How much does Avatar Comp's service cost my
company?
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I was told that it is advantageous to select
the MCO affiliated to my current TPA, what is the advantage?
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Does the selection of Avatar Comp affect my
premium?
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Can Avatar Comp put me into a group rating
program?
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Who is responsible for determining my premium
payment?
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What is a global enrollment period?
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What if I am an out of state employer and have
questions regarding my
Ohio Workers' Compensation claims process or need on site
training?
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Does Avatar Comp provide any on-line access to
assist me with claims
management?
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What is Avatar Comp's hours of operations?
1. How did Avatar Comp become my Managed Care Organization (MCO)?
Avatar Comp became your MCO because you either selected Avatar
during one of the Bureau’s global open enrollment periods, which
occur every two years, or you were assigned to Avatar because
you did not specifically designate a MCO. The State of Ohio may
assign a MCO to any employer conducting business in Ohio.
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2.What
should I expect from Avatar Comp?
A team of dedicated nurses and claim specialists who work
together in managing your workers compensation needs. Avatar is
unique in that we are available twenty-four hours a day,
three-hundred and sixty-five days a year. Avatar provides
education to your employees and providers on how to take a
proactive approach to safety. This is the best avenue in
preventing injuries which
increases your profitability. Avatar can individualize our
services to specifically meet the needs of your organization.
We understand that each employer is unique and has varied
expectations. It is our goal to facilitate a comprehensive
collaborative approach with the Ohio Bureau of Workers'
Compensation, provider, and any TPA (Third Party Administrator)
or legal representative involved in your claims process.
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3.
Why
did the Bureau assign a MCO, I did not select Avatar Comp, nor
do I have any claims?
When you apply for workers' compensation coverage, you have the
choice to select a managed care organization (MCO). If you do
not specify a specific MCO, the Bureau may
randomly assign one of Ohio's MCO's to medically manage
your claims, or any potential claim you may have in the future.
As a State Fund Ohio employer, you must
have a managed care organization. It is for this reason,
that the Bureau may have automatically assigned Avatar Comp to
your company.
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4.
Why
hasn't Avatar Comp contacted my company?
As soon as Avatar is notified by the Ohio Bureau of Workers'
Compensation that an employer has selected or been assigned to
us, we send a welcome packet (claims kit) that introduces
ourselves and the workers compensation process. The claims kit
will contain MCO identification cards,
which your employees should have in the event that an industrial
injury occurs. This card contains all of the information
a treating physician would need to quickly notify us and let the
case management process begin.
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5.
What
if I want a meeting with Avatar Comp (on-site or off-site) to
discuss my claims or arrange for specific training?
Simply contact Avatar via phone or email, and we will schedule a
meeting with you to best develop an individualized plan that
meets your organizations needs. Avatar will come on-site and
work with your supervisors, or employees to better educate them
on the claims management process. We can partner with you to
put an efficient cost effective program in place that will focus
on reducing your frequency, severity, and lag time. There are a
variety of Bureau sponsored programs available, such as the
Transitional Work Program (TWP), that will assist in the
development of a written claims protocol should an industrial
injury occur. We will work with all parties of a claim to
facilitate a quick and safe return to work.
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6.
How
much does Avatar Comp's service cost my company?
The services provided by any managed care organization are
included in your premium payment to the State of Ohio for
Workers' Compensation coverage. There is no variation in cost
associated with your selection of any of the managed care
organizations available in Ohio. MCO's do not set your premium,
or bill your organization for services provided in association
with
providing case management.
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7.
I was
told that it is advantageous to select the MCO affiliated to my
current TPA, what is the advantage?
There is no
advantage. Your MCO selection does not have to be connected to
your selection of a Third Party Administrator (TPA). The State
of Ohio has strict guidelines explaining what services and
functions a MCO or TPA may provide. The 2006 MCO BWC contract
states: “The MCO and any affiliated TPA, if applicable, shall
have complete separation of functions, offices, systems, and
staff. Complete separation of staff shall include but not be
limited to case management and marketing staff. The MCO and any
subcontractors must be separate legal entities any may not have
the same Bureau provider number or tax identification number.
The MCO shall not be a Bureau certified health care provider.”
The selection of any managed care organization in Ohio is solely
the choice of the employer and should not be influenced by any
external agency or affiliation.
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8.
Does
the selection of Avatar Comp affect my premium?
It is
important that an employer select a managed care organization
that will efficiently medically managed any industrial injury.
The effectiveness of returning your employees to work quickly
and safely can indirectly influence your out of pocket expenses
by impacting the “BIG 3”. The Ohio Bureau of Workers’
Compensation defines the “Big 3” as frequency, severity, and lag
time.
Specific questions regarding your premium need to be directed to
the Ohio Bureau of Workers' Compensation. The BWC may be
reached at 1-800-OHIO-BWC or by logging onto
www.ohiobwc.com .
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9.
Can Avatar Comp put me into a group rating program?
No. There are no MCO's in the State of Ohio that place employers
in a group rating program. This is a function handled by a
Third Party
Administrator (TPA). TPA's are responsible for the legal
aspects of managing your claims and do not fall under the
jurisdiction of the BWC. There is almost always an out of pocket
fee associated with services provided by a TPA. Remember, MCO's
provide claims management to quickly return your injured
employee to work which reduces the severity of your claim. This
service is covered by your premium payment to the BWC. You will
never receive a bill from Avatar for any services we provide.If
you are interested in selecting a TPA, you can contact the BWC
for a list of TPA's. An Ohio managed care organization is not
permitted to direct an employer to a specific TPA due to
firewall regulations and compliance.
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10.
Who is
responsible for determining my premium payment?
Avatar does
not bill your company for any of the services we provide.
Avatar, as a MCO, does not bill, set, or increase your premium
payment. The BWC is solely responsible for calculating
employers’ premium payment to the State of Ohio. You should
never send your premium payment to Avatar, or any MCO.
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11.
What is a
global enrollment period?
A global enrollment period occurs once every two years for a
timeframe specified by the BWC. During this time period, and
this period only, an employer may change their managed care
organization to one that might better fit their needs. Per BWC
the 2006 global enrollment period will occur May 1, 2006 through
May 26, 2006.
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12.
What
if I am an out of state employer and have questions regarding my
Ohio Workers' Compensation claims process or need on site
training?
Simply contact Avatar Comp and we will schedule an on-site
visit, regardless of your location. At Avatar Comp, we want to
be an active partner in your claims management. An active
partner does not simply supply telephonic case management. We
understand the need for face to face meetings, along with any
individualized requests you may have to better assist
in establishing a
cost effective workers compensation program. We make it our
goal to know the needs of your business. You can contact Avatar
Comp by telephone or email. Simply visit the "Contact Us" tab
from the main menu for your contact options.
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13.
Does
Avatar Comp provide any on-line access to assist me with claims
management.
Absolutely, we can provide custom real-time read only access to
your claims upon request. Also, the Ohio Bureau of Workers'
Compensation has now made available MCO and BWC notes via their
website at
www.ohiobwc.com .
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14.
What
are Avatar Comp's hours of operations?
Avatar Comp representatives are available for claims assistance
seven (7) days a week, twenty-four (24) hours a day,
three-hundred sixty-five (365) days a year. We are here to
serve you.
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