Commonwealth of Virginia

What Commonwealth of Virginia does

The Commonwealth of Virginia, through its Department of Human Resource Management (DHRM) Office of Workers' Compensation (OWC), administers the state's workers' compensation program covering approximately 140 state agencies and their employees. Program operations have been outsourced since July 1, 1998 to MC Innovations (MCI), a Virginia Certified Women-Owned Small Business, under a Total Program Management model in which MCI serves as the single general contractor; the program is currently operating under its fifth contract with MCI (effective July 1, 2018). MCI sub-contracts specialized services including Sedgwick (web-based claims reporting via the Visual Liquid Web / Employer Accident Report Portal and viaOne Self-Service Portal for provider bill status), Alius Health (pharmacy network and First Fill Pharmacy Card), Genex Services (telephonic nurse case management and medical/vocational services), Rockport Healthcare Group / CareWorksPPO and Virginia Healthcare Network (PPO medical provider access), and LCI (loss control consulting). Funded entirely through state budget appropriations rather than commercial sales, the program delivered a 99% return-to-work rate in FY23 (the thirteenth consecutive year at 98–99%), $11M+ in cost avoidance in FY23, $461,510 in subrogation recoveries, and an average disability duration of 32.14 days — a 3.48% reduction versus the three-year average. Coordinator enablement is delivered through the Virginia Learning Center (distance learning), the quarterly INNOVATOR newsletter, an annual roadshow, library of training videos, and safety officer networking meetings.

Name

Commonwealth of Virginia

Legal name

Commonwealth of Virginia

Website

https://covwc.com

Company type

Private

Founded year

1997

Operating status

Operating

Headcount range

11–50 employees

Short description

The Commonwealth of Virginia, through its DHRM Office of Workers' Compensation, administers the state workers' compensation program for approximately 140 state agencies, with operations outsourced since 1998 to MC Innovations under a Total Program Management contract.

Ownership category

akta.pro rank

Product category

Workers' Compensation Claims Administration (Government Program)

NAICS

Administration of Human Resource Programs (9231), Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs) (92313), Vocational Rehabilitation Services (6243)

SIC

Hospital & Medical Service Plans (6324), Services-Membership Organizations (8600)

akta.pro primary industry

Workers’ Compensation & Occupational Health TPA (HLAEALAL)

akta.pro secondary industries

Work Injury & Workers’ Compensation / Occupational Injury Benefits (BPAIAKAJ), Managed Workers’ Compensation (Loss Control, Claims & Return-to-Work Programs) (FSAJAEAH), Self-Insured Workers’ Compensation Programs (FSAJAEAD)

Keywords

• Workers compensation claims
• Return-to-work programs
• Medical bill adjudication
• Pharmacy network management
• Loss control services

Headquarters

HQ city

Richmond

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. State Budget Allocation: The Commonwealth of Virginia funds the Workers' Compensation Program through state government budget allocations. The program is administered through the Department of Human Resource Management (DHRM), Office of Workers' Compensation (OWC), with services contracted to MC Innovations (MCI).

Distribution channels1 record

Marketing channels6 records

Core offering

The Commonwealth of Virginia operates the state Workers' Compensation Program, providing comprehensive claims management, medical bill adjudication, return-to-work coordination, pharmacy network access, and loss control services for over 140 Virginia state agencies and their employees. Delivered under Total Program Management by MC Innovations (MCI) with Sedgwick-powered web-based claims reporting, the program manages injury reporting, medical provider services, telephonic nurse case management, and end-to-end benefits administration funded through state budget appropriations.

Product overview

The Commonwealth of Virginia Workers' Compensation Program is a comprehensive, outsourced claims management system administered through the Office of Workers' Compensation (OWC) within the Department of Human Resource Management. The program is delivered under Total Program Management by MC Innovations (MCI), a Virginia Certified Women-Owned Small Business, operating under its fifth contract effective July 1, 2018. The core platform consists of a Sedgwick-powered web-based claims reporting system (Visual Liquid Web/FROI Portal) integrated with specialized service modules including: Medical and Vocational Services (telephonic nurse case management, field medical/vocational consultants, medical director); Pharmacy Network (Alius Health pharmacy benefit with locator and First Fill Card); Medical Provider Services (viaOne Self-Service Portal for bill payment); Physician Panels; Return-to-Work Program; Physical Capabilities Evaluation; Loss Control Services; and the Virginia Learning Center for training. The system serves all Virginia state agencies and their employees, processing workers' compensation claims with the goal of controlling costs, facilitating timely medical treatment, and returning injured workers to gainful employment.

Differentiator

Problem solved

Functional benefit

Brands

• INNOVATOR Newsletter: The program's newsletter providing tips and techniques for workers' compensation management, published regularly since 2015.

Products and services

• Workers' Compensation Claims Management Platform Web-based claims reporting and management system powered by Sedgwick, providing electronic form processing for first report of injury claims, enhanced accessibility, and accelerated claim resolution for Virginia state agencies and their employees.
• Pharmacy Network (First Fill Card) Integrated pharmacy benefit program provided through Alius Health, including a searchable pharmacy locator (by zip code, city, state, or pharmacy name) and the First Fill Pharmacy Card, enabling injured workers to obtain medications without out-of-pocket expenses.
• Medical Provider Services (viaOne Provider Gateway) Provider gateway and ACH payment enrollment service powered by Sedgwick CMS, enabling medical providers to look up bill payment status and receive automated invoice payments for workers' compensation claims.
• Medical and Vocational Services Field medical and vocational services including telephonic nurse case management, medical director services, medical vocational rehabilitation, and regional medical and vocational consultants deployed across Virginia.
• Physician Panels Virginia-compliant panel physician offerings required for injured employees, including panel physician forms and guidance for developing compliant physician panels per state requirements.
• Return-to-Work Program Program assisting individuals with work-related illness or injury through early referral, transitional return-to-work, modified duty accommodations, and job analysis services to support durable return to gainful employment.
• Physical Capabilities Evaluation Evaluation service creating detailed accounts of injured workers' job physical demands for treating physicians, used with Employee Worker Profiles to facilitate return-to-work determinations.
• Loss Control Services Safety consulting offering including Loss Control services, Safety Officer Networking Meetings, toolbox topics, safety training programs, F.O.C.U.S. Catalog of Safety Topics, and articles on workplace safety for Virginia state agencies.
• Virginia Learning Center Distance learning platform hosted at covlc.virginia.gov providing Workers' Compensation 101 training, roadshow sessions, and ongoing education for workers' compensation coordinators and agency staff.

Quantifiable outcome

• 99% Return-to-Work Rate
• +4 more outcomes

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• MC Innovations (MCI)coreImplementation/ SI/ Consulting Partner · 1 July 2018MC Innovations serves as the General Contractor for the Commonwealth of Virginia Workers' Compensation Program under Total Program Management. MCI provides single contract administration, fiduciary accountability, and management of all services. Currently operating in its fifth contract (effective July 1, 2018). MCI is a Virginia Certified Small Business and majority woman-owned business.
• Sedgwick (fka York Risk Services)coreTechnology or IntegrationSedgwick provides the web-based claims reporting system (Visual Liquid Web portal), medical bill review services, and centralized finance services including check printing and mailing from Dublin, Ohio office.
• Alius HealthcoreTechnology or IntegrationAlius Health provides pharmacy benefit management services including the First Fill Pharmacy Card program, allowing injured workers to receive medications without out-of-pocket costs.
• Rockport Healthcare Group (CareWorksPPO)coreTechnology or IntegrationPart of the PPO network accessed through MC Innovations for workers' compensation medical provider services.
• Virginia Healthcare NetworkcoreTechnology or IntegrationStatewide PPO network partner for workers' compensation medical provider services.
• Genex ServicescoreImplementation/ SI/ Consulting PartnerProvides telephonic nurse case management and medical/vocational services for the workers' compensation program, with regional medical coordinators and vocational specialists across Virginia.
• Virginia Retirement System (VRS)minorStrategic or Co-development PartnerCoordination of Return To Work information with the Virginia Retirement System for VSDP (Virginia Sickness and Disability Program).
• Department of Human Resource Management (DHRM)coreStrategic or Co-development PartnerOversight agency for the State's Workers' Compensation Program through the Office of Workers' Compensation (OWC), providing management oversight, policy direction, and agency relations support.

Scale indicators8 records

Recent moves6 records

Expansion highlights4 records

Direct peers

• Sedgwick: Largest U.S. workers' compensation TPA. Sedgwick powers the COVWC claims platform (Visual Liquid Web) and provides bill review and check processing; directly comparable as a WC TPA serving public- and private-sector clients.
• MC Innovations (MCI): Virginia-certified women-owned small business operating as the Total Program Management general contractor for COVWC. Comparable as a niche WC program management firm, though its portfolio is anchored to this single Virginia contract.
• Genex Services: Provides telephonic nurse case management, medical/vocational services, and field medical coordination for COVWC. Directly comparable as a WC medical case management and utilization management vendor.
• CorVel Corporation: National WC managed care and TPA provider offering claims management, case management, bill review, and networks. Closely aligned with COVWC's service model across multiple states and employer types.
• Helmsman Management Services (Liberty Mutual): WC TPA within Liberty Mutual providing claims, managed care, and return-to-work services. Comparable as an integrated WC program administrator serving large employers and public entities.
• Broadspire (Crawford & Company): Third-party administrator offering WC claims management, medical management, and integrated disability services. Comparable as a full-service WC TPA with similar scope to COVWC's outsourced model.
• PMA Companies: Workers' compensation insurance carrier and TPA providing managed care, claims, and risk control services. Comparable in offering Total Program Management-style WC services to employers and public entities.
• Careworks (CareWorks Comp360): WC managed care services vendor that handles bill review for the COVWC program. Comparable as a WC bill review and utilization management specialist with similar niche scope.
• Alius Health: Pharmacy benefit manager operating the First Fill Pharmacy Card program for COVWC. Comparable as a workers' compensation pharmacy network and PBM vendor.

Broad incumbents

• California State Compensation Insurance Fund: State-run workers' compensation insurance fund covering California employers. Comparable as a public-sector, state-mandated WC program with self-insurance characteristics analogous to COVWC's self-funded state employee model.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/managed-care-innovations

Revenue estimate

Valuation estimate

Number of profiles

Profiles9 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Commonwealth of Virginia