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
Methods for payment of the value of a policy. An insurance company can select one of three options in settlement of a loss: make a cash payment; take possession of damaged or destroyed ...
Representative of an insurance company who sells ordinary and industrial life insurance policies. In an effort to move their field forces into the ordinary life business, many industrial ...
Coverage in liability insurance for a ship owner in the event of collision with another ship. A running down clause, when added to basic hull marine insurance, protects against liability ...
Provision in most property insurance policies that permits a policyholder to use the insured premises to store materials and handle them in the manner needed to pursue his or her line of ...
Inland marine policy that protects an insured against loss for property that is shipped. One policy may be written for a single shipment, as for a family moving household goods, or it may ...
Maritime acts resulting in a liability circumstance falling under common law and statutory law. ...
Aggregate of face amount of coverage paid up, or on which premiums are still being paid, as issued by a life insurance company. This is one measure used to rank life insurance companies by ...
Total premiums written by a ceding company minus premiums ceded to its reinsurer. ...
Notice added to the employee retirement income security act (erisa) requiring the employer to disclose the following information concerning the pension plan to the employee: statement ...
Have a question or comment?
We're here to help.