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.