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
Model act written and published by the national association of insurance commissioners (naic) whose purpose it is to regulate brokers who control insurance companies. The act permits the ...
Method of pricing property and liability insurance. It uses charges and credits to modify a class rate based on the special characteristics of the risk. Insurers have been able to develop a ...
Cancellation of an insurance policy on the date that policy becomes effective. This type of cancellation does not require any fees to be paid to the insurance company. ...
Endorsement to a homeowners insurance policy or a personal automobile policy (pap) that covers physical damage to a snowmobile wherever it happens to be. Coverage can be on named peril or ...
Extension of a Workers Compensation and Employers Liability Insurance policy to cover workers who go aboard ship to perform their jobs. ...
Same as term Dividend Addition: option in a participating policy under which dividends are used to purchase fully paid-up units of whole life insurance. This option deserves careful ...
Coverage on an all risks basis for loss or damage to fur and jewelry at any location. Furs and jewelry must be scheduled in order to be covered. ...
Statistic indicating the degree of dispersion in a set of outcomes, computed as the arithmetic mean of the differences between each outcome and the average of all outcomes in the set. ...
Form of insurance whereby the buyer (reinsurer) assumes the entire obligation of the cedent company, effected through the transfer of the policies from the cedent to the books of the ...
Have a question or comment?
We're here to help.