Managed Care Organization (mco)
Definition of "Managed care organization (mco)"
Entity that offers a managed care plan for workers compensation benefits that joins a provider network with the following parts: case management personnel, medical bill review personnel, internal dispute resolution vehicle, written guidelines for treatment of cases, quality assurance program, and a utilization review committee. This mechanism executes in the following manner:
- Case management personnel monitors treatment of an injured employee to make sure the employee recovers from illness and returns to work in a timely fashion.
- Guidelines for treatment of cases written criteria for determining when an illness requires medical treatment, scope of the medical treatment, and acceptable disability time periods.
- Internal dispute resolution vehicle provides written instructions for procedures to resolve conflicts in issues between health providers and fee payers regarding the size of medical fees charged, type and scope of medical treatment, and over utilization of medical facilities.
- Utilization review committee provides guidelines for inpatient hospital care, outpatient care, and physician care.
Popular Insurance Terms
Policy in which a premium (the deposit) is paid in the first policy year, in addition to the regular term insurance premiums required. The deposit is left to accumulate at interest for a ...
Long-term investment plan strategy under which all of the investor's investable assets are divided into predetermined proportions among several different types of securities. In theory, ...
Determination that investments by parents in their children's education through the purchase of Series EE Savings Bonds, which generate interest income, are tax-exempt if the proceeds are ...
Money withdrawn by an employee from benefits owned. When an employee exercises this right, future benefits purchased by the employer on behalf of the employee are usually forfeited. ...
Policy that pays a dividend to its owner. ...
Inquiry conducted by a committee of the legislature of the State of New York in 1905 that looked at abuses of life insurance companies operating in the state. This study led to stricter ...
Omissions from coverage found in products liability insurance. The policy does not provide coverage if the business manufactures a product that does not meet the level of performance as ...
Model state law of the NAIC that requires the insurance agent who is replacing the policy to: give the policyholder a replacement notice; forward a signed copy of the replacement notice to ...
Coverage for persons whose medical history includes serious illness such as heart disease or whose physical condition is such that they are rated below standard. A policy may specifically ...
Have a question or comment?
We're here to help.