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
Minimum amount of coverage for which a company will write a liability insurance policy. ...
Record a debit (or other) agent makes for premiums collected, time period for which the policy is paid, and the week of collection or date the premium was paid. In essence, the debit agent, ...
In a commercial general liability (comprehensive general liability) policy, exclusion of coverage for sold premises. The objective of this exclusion is to eliminate coverage for property ...
Trust in which assets are controlled through several generations and makes use of generation-skipping tax exemption. ...
Same as term Associate in Research and Planning: professional designation earned after the successful completion of six national examinations given by the insurance institute of America ...
Same as term Cargo Insurance: shipper's policies covering one cargo exposure or all cargo exposures by sea on all risks basis. Exclusions include war, nuclear disaster, wear and tear, ...
Qualified pension or other employee benefit where responsibility rests with an employer rather than an insurer. A trust fund plan, where assets are deposited with and invested by a trustee, ...
Individual who has a contractual agreement with a policyowner. The agent of record has a legal right to commissions from the insurance policy. ...
Net income expressed as a percentage of average total assets. This percentage measures profitability by expressing the efficiency of asset utilization. ...
Have a question or comment?
We're here to help.