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
Marketing of insurance through independent agents; also called independent agency system. Independent agents usually represent several insurance companies and try to insure the risk ...
Search engine site that emphasizes the fields of environmental risk management, environmental engineering, environmental planning, physical and biological sciences, and various ...
Method of funding a pension plan under which a single premium payment is made to fund a single unit of benefit for one year of recognized service with the employer. For example, if the ...
In automobile insurance, coverage providing protection in the event of physical damage to the insured's own automobile (other than that covered under comprehensive insurance) resulting from ...
Liability reserve required to be maintained by the national association of insurance commissioners (naic) prior to 1992 for fluctuations in the values of investments in securities. Realized ...
Means of paying the cost of benefits of pension plan participants including retirement, death, and disability. ...
Law that stipulates the minimum reserve the life insurance company must maintain for its life insurance policies and annuity contracts. This law was first developed by the NAIC as a method ...
Insurance established under the federal Railroad Retirement Act for railroad employees, covering death, retirement, disability, and unemployment. Benefits are adjusted for cost of living ...
Two basic kinds of policies sold by health insurance companies: medigap insurance (medicare supplementary insurance); and medicare wraparound ...
Have a question or comment?
We're here to help.