Form Focus: Ohio Request for Injured Worker Outpatient Medication Reimbursement (C-17)

Columbus, OH (WorkersCompensation.com) -- In Ohio, form C-17, the Request for Injured Worker Outpatient Medication Reimbursement is used for medication reimbursement, including over-the-counter medications.

The following breaks down the requirements that accompany the form.

Prescription Requirement. The medication must be written as a prescription and dispensed by an enrolled pharmacy. Medications purchased at a physician’s office for at-home use are non-reimbursable.

Medical Supplies. A C-17 is not used for medical supplies, durable medical equipment, and other non-drug reimbursement items. These items should be billed directly to the managed care organization.

C-17 Instructions.
> A separate C-17 is required for each pharmacy.
> All sections, including worker and pharmacist signature, must be completed.
> Prescription labels or a pharmacy printout with pricing information must be sent. While photocopies are acceptable, a pharmacy cash register receipt is not acceptable.
>Change Healthcare must receive the C-17 within one year from the date of service.
> The C-17 and prescription labels with pricing information must be mailed to:

Change Healthcare
P.O. Box 769
Augusta, ME 04332

Reimbursement. Waiting to mail the C-17 until after the Bureau of Workers' Compensation has approved the claim will help prevent delays in reimbursement.

The reimbursement process goes as follows:
> Within three weeks of receiving a completed C-17, Change Healthcare will mail a check for reimbursement.
>Within 7 days of receiving a C-17 that could not be process, Change Healthcare will mail a letter explaining why reimbursement could not be processed.
> Reimbursement will be considered for prescriptions that meet the requirements of BWC's outpatient medication formulary and payment rules.
> Brand-name medications are reimbursed at the generic drug price when a generic medication was available.

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