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Employers or their representatives use this form to select a managed care organization (MCO) to medically manage their workers' compensation claims. Complete the form you received in your enrollment toolkit and mail in.If you do not choose an MCO the State will automatically assign you to an MCO. While completing your Maryland Medicaid application, you will be asked to choose a Managed Care Organization (MCO). You can change your Medicaid MCO once a year. Name of MCO selected: MCO number: MCO Selection Form. Complete this form, then mail or fax it to BWC using the address or fax number found below. Download and complete the Spooner MAI MCO selection form, and return it to Spooner MAI via fax, email or US mail. Ohio Managed Care Organization. (MCO) selection form.