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
Insurance transactions conducted across national boundaries. Such transactions occur when the insurance company sells insurance outside the country of the company's domicile. ...
Time frame during which an annuitant makes premium payments to an insurance company. The obligations of the company to the annuitant during this period depend on whether a pure annuity or ...
Organization that underwrites insurance policies. There are two principal types of insurance companies: mutual and stock. A mutual company is owned by its policy owners, who elect a board ...
Act by a person who is terminally ill of cashing in a life insurance policy to pay for the necessary associated illness, medical expenses, and final wishes. This terminally ill person ...
Coverage that will indemnify the insured for the expenses, up to the limits of the policy, if a building is damaged by a peril such as fire, and zoning requirements and/or building codes ...
Detail showing distribution of property coverages written by an insurance company. Illustrates a potential danger of concentration of insured risks. ...
Entitlement of a participant in an employee benefit insurance plan to receive benefits regardless of his or her employment status. ...
Under a general liability policy, a claim by an employer arising when an employee terminated by a supervisor without authority or just cause brings suit against the employer. Such a claim ...
Complete coverage for hospital and physician charges subject to deductibles and coinsurance. This coverage combines basic medical expense policy and major medical policy. ...
Have a question or comment?
We're here to help.