Ohio Admin. Code 4123-6-14.1 - Records to be retained by MCO

(A) An MCO shall retain records received from providers and subcontractors that are utilized by the MCO to develop electronic billings to the bureau. The MCO shall retain any records obtained from the providers and subcontractors that are utilized by the MCO to perform its medical management functions, or to substantiate the delivery, value, necessity, and appropriateness of goods and services provided to injured workers, and to develop electronic billings to the bureau. The

(1) The MCO shall retain records relating to a claim so long as the industrial commission and bureau of workers' compensation have continuing jurisdiction over the claim pursuant to section 4123.52 of the Revised Code. For records that do not relate to a specific claim, including but not limited to monthly bank statements, monthly bank records and reconciliations, and monthly check registers, the MCO shall also create, maintain, and retain for a period of seven years from the date of the transaction records documenting transactions with the injured worker, providers, and subcontractors.

(2) The MCO shall also create, maintain, and retain records documenting transactions with the injured worker, providers, and subcontractors that do not relate to a specific claim, including but not limited to monthly bank statements, monthly bank records (e.g., deposit slips), account reconciliations and all supporting documentation (e.g., monthly check registers, outstanding check lists, voided transactions), and general and subsidiary ledger accounting records for a period of seven years from the date of the transaction.

(B) The failure of an MCO to create, maintain, and retain such records shall be sufficient cause for the bureau to deny payment for goods or services, or for performance fees, or for declaring overpaid previous payments made to the MCO, and may be cause for decertification.

(C) As used in this rule, "records" includes, but is not limited to, "record" and "electronic record" as defined in rule 4125-1-02 of the Administrative Code.

Notes

Ohio Admin. Code 4123-6-14.1

Effective: 4/1/2021
Five Year Review (FYR) Dates: 1/5/2021 and 08/01/2025
Promulgated Under: 119.03
Statutory Authority: 4121.12, 4121.121, 4121.30, 4121.31, 4121.44, 4121.441, 4123.05
Rule Amplifies: 4121.12, 4121.121, 4121.44, 4121.441
Prior Effective Dates: 01/15/1999, 01/01/2001, 09/01/2013