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
Rate not subsequently adjusted. The rate stays in effect regardless of an insured's subsequent loss record. ...
Same as term Fortuitous Loss: loss occurring by accident or chance, not by anyone's intention. Insurance policies provide coverage against losses that occur only on a chance basis, where ...
Insurance protection written in the form of a single line policy. ...
Provision in the extended coverage endorsement stating that smoke damage is covered when it results from the sudden, unusual, and faulty operation of an on-premises cooking or heating unit, ...
Addition to the pure cost of insurance that reflects agent commissions, premium taxes, administrative costs associated with putting business on an insurance company's books, and ...
Federal program to insure private U.S. investments in foreign countries, created by the Foreign Assistance Act of 1961. It is a joint government and private effort to encourage U.S. ...
Adjustment of the burning cost ratio for the increase in number and size of losses (losses likely in excess of that used in the unadjusted burning cost rate), incurred but not reported ...
Estimated future dividends to be paid by a participating insurance policy. These dividend estimations cannot be part of the policy since they are not guaranteed. They are normally shown in ...
Bond derivatives of short-term duration whose principal or coupon value is determined by a market index. Market indexes that can be utilized include securities, commodity prices, and ...
Have a question or comment?
We're here to help.