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
Average interest earned by an insurer on its investments after investment expense, but before federal income tax. ...
Part of the Balanced Budget Act of 1997 that permits medicare recipients to select coverage among various private health care plans to include HMOS, PPOS, POINT-of-SERVICE (POS), MEDICAL ...
Life insurance that pays the balance of a mortgage if the mortgagor (insured) dies. Coverage is usually in the form of decreasing term insurance, with the amount of coverage decreasing as ...
Individual who retains title to property that is being transferred on a temporary basis to the care, custody, and/or control of another. ...
Rate of return computed by dividing the current annual dividend (if a stock) or annual coupon amount (if a bond) by the amount paid for that financial instrument. ...
Utilization of life insurance to make annual gifts into a trust in order to produce the largest tax-free death benefit possible to the trust beneficiaries. ...
Death from other than accidental means. ...
Amendment to a will that adds or modifies clauses in that will, such as adding an additional beneficiary or piece of property. ...
Bureau insurer that files its statistical and underwriting experience with a rating bureau. ...
Have a question or comment?
We're here to help.