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
cost of annuity based on expectation of life of the annuitant and the expense and profit loadings of the insurance company. ...
Coverage on an all risks basis for fur garments belonging to customers of a furrier. ...
a contract in life insurance that includes elements of whole life and term insurance. in pensions, a combined life insurance policy and a side (auxiliary) fund to enhance the amount of a ...
Payments in excess of the value of the loss a prohibited practice. When an insured has more than one policy covering a risk, the full value cannot be collected from each policy if a loss ...
Option to an insurance company to replace, reconstruct (repair), or reproduce (rebuild) damaged or destroyed property covered by property insurance rather than indemnify an insured in cash. ...
Premium rate charged by the insurance company (insurer), which is below the standard rate. ...
Trust that cannot be revoked by the creator. ...
Incidents covered under workers compensation benefit. ...
Coverage during the transfer of securities and monies, precious metals, and other specified types of valuables by armored guard services. Policies are specifically designed to fit an ...
Have a question or comment?
We're here to help.