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
Independent agency supported by the insurance industry that tests a variety of materials, products, and devices, such as appliances and electrical equipment, to assure that they meet safety ...
In property insurance policy, clause that stipulates that if legislative acts or acts of the insurance commissioner's office expand the coverage of an insurance policy or endorsement forms ...
Type of mutual insurance company that requires a substantial initial premium payment. After the initial premium payment is made, future premium payments required will be paid from the ...
Combination of property insurance on the hull of an airplane and liability insurance in the following manner: property coverage provided on an ALL RISKS basis or on a specified perils ...
Quality of investments of insurance companies. State insurance regulators establish rules for company investments. Authorized investments vary, depending on whether a company is a life ...
Trust that qualifies assets under the marital deduction provision in the Federal Tax Code for favorable treatment of an estate. The surviving spouse has the full power to use the assets of ...
Reinsurance broker for a primary company (the re-insured). This broker is paid commissions by the reinsurance company, just as an agent is paid commissions by an insurance company for ...
Coverage for an employer in the event of dishonesty of any employee. ...
Provision for every citizen of the United States to be guaranteed by law the right to purchase health insurance and is required by law to make such a purchase. ...
Have a question or comment?
We're here to help.