Difference Between an MCO and a TPA
- Category: Insurance Programs
What is the Difference Between an MCO and a TPA?
What is an MCO?
- MCOs medically manage work-related injuries and illnesses.
- Collecting initial workplace injury reports and transmitting them to BWC.
- Management and authorization of medical treatment provided to injured workers.
- Medical review and bill payment processing.
- Maintaining a network of BWC-certified healthcare providers.
- Return to work services.
- Utilization review.
- Training and education for both employers and injured workers.
- Providing peer reviews as necessary for treatment decisions; and, Processing treatment appeals through the Alternative Dispute Resolution (ADR) process.
- Paid by the BWC and are an independent party.
What is a TPA?
- TPAs assists employers in the administrative and financial aspects of Ohio workers’ compensation claims.
- Providing risk management consulting to employers.
- Administering group rating and other savings and discount programs to lower an employer’s Ohio BWC premium.
- Pertinent claims investigation.
- Claims administration.
- Industrial Commission hearing attendance.
- Paid by the employer and are an employer representative.