How to Fill Out and Submit Ohio BWC Form MEDCO-31: Prior Authorization

The Ohio BWC MEDCO-31 form is the Physician’s Request for Medication/Prior Authorization that prescribers fax to the injured worker’s Managed Care Organization when a drug falls outside the Bureau of Workers’ Compensation outpatient formulary or otherwise requires approval. You complete the form, attach recent office visit notes, fax everything to 1-866-213-6066, and the MCO must issue a decision within three business days.¹

When You Actually Need to Submit This Form

The BWC maintains an outpatient medication formulary under Ohio Administrative Code 4123-6-21.3.² Any drug not on that list needs prior authorization through the MEDCO-31 before a pharmacy can fill it and get reimbursed. A listed drug can also require prior authorization if it exceeds a cost threshold, is prescribed outside its FDA-approved use, sits in a flagged therapeutic class, or is requested beyond a set time frame from the injury date or last fill.³

The formulary also sets supply limits (maximum days per fill) and quantity limits (maximum units per fill). When a patient’s situation calls for exceeding either, the MEDCO-31 is how you ask.²

Two specific scenarios warrant extra attention. If you’re writing “dispense as written” for a brand-name drug when a generic equivalent exists, the BWC will cover the full brand price only when the worker had a documented systemic allergic reaction to the generic, or tried the generic and either saw no benefit or had an unacceptable adverse event.³ That history belongs in the justification section. Opioid requests must include the supporting documentation required under OAC 4123-6-21, and the BWC reimburses opioids only when the prescriber follows the practices in OAC 4731-11-13 and 4731-11-14.¹

Completing the Form Section by Section

Download the current MEDCO-31 (BWC-3931, revised March 9, 2026) from the BWC’s Forms and Publications page at info.bwc.ohio.gov.⁴ The form is short. The justification is where requests succeed or fail.

Claim Identification

The top of the form connects the request to the right electronic claim file. You need the injured worker’s full legal name as it appears in the BWC system, the BWC claim number, and the date of injury on record. Pull these from BWC records rather than intake paperwork; mismatches delay processing because the MCO can’t match the request to a claim. The BWC’s online claim lookup tool can confirm the number if you don’t have it.

Medication Details

Enter the exact drug name and strength per unit (for example, “gabapentin 300 mg capsule”) and the ICD code for the condition you’re treating. The diagnosis must be an allowed condition in the worker’s claim. A code for a condition the BWC has not recognized in that claim will trigger a denial before the MCO reaches the clinical merits.

Justification and Attachments

The form asks for a detailed explanation of how the requested medication relates to treating the work-related injury and the allowed conditions in the claim.¹ In practice that means naming the formulary alternatives you considered, describing what was tried (drug, dose, duration, response or adverse effect), and explaining why the requested drug is the right next step. “Patient needs this medication” gets denied. Specifics get approved.

Recent office visit notes must be attached. For medications tied to surgery, attach documentation showing the MCO approved the procedure. For opioids, include the OAC 4123-6-21 documentation.

Where to Send It

Fax the completed MEDCO-31 and every supporting document to 1-866-213-6066.¹ The request routes to the MCO assigned to the worker’s claim, not to the central BWC office. If you’re not sure which MCO handles the claim, the BWC provides a lookup by claim number on its website.⁵

Keep a copy of everything, including the fax confirmation. If the MCO asks for more records during review, the originals need to be at hand.

What Happens Next

The MCO must give the physician a decision within three business days of receiving the request.⁶ Clinical staff review the medical necessity, the justification, and the visit notes. The MCO may reach out for additional records if the submission is thin. Both the injured worker and the prescribing provider receive written notice of the decision. A denial notice spells out the specific reasons, which tells you exactly what to fix.

Why Requests Get Denied

Most denials come from a short list of avoidable problems:

Diagnosis mismatch. The ICD code doesn’t match an allowed condition in the claim.
Weak justification. No specifics on what was tried, at what dose, for how long, with what result.
Missing office visit notes. The form requires them; submitting without them is the fastest denial.
No surgery approval attached when the drug follows a procedure.¹
Opioid requests without the OAC 4123-6-21 documentation.

Ten extra minutes on the justification and complete visit notes on the first submission saves weeks.

If the MCO Denies the Request

Providers have 14 days from receipt of the denial to file a medical treatment dispute.⁷ Miss the window and you lose the right to contest that denial.

Read the denial reasons first. If the MCO denied for thin justification or missing notes, a new MEDCO-31 with stronger documentation is usually faster than the formal dispute. When the MCO disagrees that the drug is medically necessary at all, the dispute route is the right path. If that doesn’t resolve it, the next level is an appeal to the Ohio Industrial Commission using the IC-12 Notice of Appeal.⁸

1
Ohio Bureau of Workers’ Compensation. MEDCO-31 Physician’s Request for Medication/Prior Authorization
2
Ohio Legislative Service Commission. Rule 4123-6-21.3 – Outpatient Medication Formulary
3
Ohio Legislative Service Commission. Rule 4123-6-21 – Payment for Outpatient Medication
4
Ohio Bureau of Workers’ Compensation. Forms and Publications
5
Ohio Bureau of Workers’ Compensation. Viewing Claim Information
6
Ohio Bureau of Workers’ Compensation. Requesting Treatment Approval
7
Ohio Bureau of Workers’ Compensation. FAQs for Providers
8
Ohio Bureau of Workers’ Compensation. Appealing a Claim Decision