Managed Care Organization (mco)

Definition of "Managed care organization (mco)"

Beth Ann Muehling PLLC real estate agent

Written by

Beth Ann Muehling PLLCelite badge icon

Xena Vallone Realty Inc

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:

  1. 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.
  2. 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.
  3. 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.
  4. Utilization review committee provides guidelines for inpatient hospital care, outpatient care, and physician care.

image of a real estate dictionary page

Have a question or comment?

We're here to help.

*** Your email address will remain confidential.
 

 

Popular Insurance Terms

Effort by an individual to continue to receive disability income benefits by taking a continuing sickness or injury. ...

Circumstance where an insurance company takes the place of an insured in bringing a liability suit against a third party who caused injury to the insured. For example, if a third party, ...

One that provides group health or pension benefits for a multiemployer plan. To lower the cost, small firms band together to take advantage of the economies of large group underwriting. ...

Insurance company formed according to the legal requirements of a foreign country. In order for an alien insurer to be able to carry on general operations and sell its products in a ...

Direct payment to a new custodian for a retirement plan. This payment is not a taxable event since it is not a distribution. The payment must be between like plans; for example, one ...

Life insurance in which the debit system is used to collect premiums on a monthly basis. ...

In health insurance, the applicable average rate charged for a semiprivate room in the geographical area in which the charge is incurred. ...

In property insurance policies, provision that excludes the insurance company's liability for indemnification of the insured for the insured's expenses incurred in the demolition of ...

The definition of special acceptance explains how two insurance institutions work together for the benefit of the masses. In order to define what special acceptance means, we must ...

Popular Insurance Questions