Managed care organization definition

Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

Managed care organization means an organization, having a

Managed care organization means a person:

Examples of Managed care organization in a sentence

• Contractor shall follow the EOHHS policy and procedures document titled, “EOHHS Medicaid Managed Care Organization (MCO) Requirements for Medicaid Member Demographic Changes.

• Managed Care Organization (MCO) Provider Tax AB 119 specifies the renewal of an enrollment-based tax on managed care organizations effective April 1, 2023, through December 31, 2026, subject to federal approval, resulting in an estimated net General Fund benefit of $19.4 billion over the tax period to be used to maintain the Medi-Cal program and support increased investments.

• Valid third party insurance denials: The Provider agrees to submit valid documentation of denials from third party payers within 60 days of receipt of the Explanation of Benefits from the insurance company of Medicaid Managed Care Organization.

• To remain eligible for Transitional Pay, the Employee must cooperate with, meet when reasonably requested, and respond to information requests from the Managed Care Organization (MCO), Third-Party Administrator (TPA), Risk Manager, health providers, and his/her supervisor.

• Further, if this Agreement is between a Managed Care Organization and an IPA/ACO, or between an IPA/ACO and an IPA/ACO, such clauses must be included in IPA/ACO contracts with Providers, and Providers must agree to such clauses.

More Definitions of Managed care organization

Managed care organization or “MCO” means an organization formed to provide medical services and certified in accordance with OAR chapter 436, division 015.

Managed care organization or "MCO" means any entity which

Managed care organization. (hereinafter “MCO”) means an entity that has or is seeking to qualify for a comprehensive risk contract and that is: (1) a Federally qualified HMO that meets the advance directives requirements of 42 CFR §489.100-104; or (2) any public or private entity that meets the advance directives requirements and is determined to also meet the following conditions: a) makes the services it provides to its enrollees as accessible (in terms of timeliness, amount, duration, and scope) as those services are accessible to other recipients within the area served by the entity, and b) meets the solvency standards of 42 CFR §438.116.

Managed care organization means an organization, having a certificate of authority or certificate of registration from the office of the insurance commissioner, that contracts with the authority under a comprehensive risk contract to provide prepaid health care services to enrollees under the authority's managed care programs under chapter 74.09 RCW.

Managed care organization. (“MCO”) means an organization formed to provide medical services and certified under these rules.

Managed care organization means an entity for which the Department for Medicaid Services has contracted to serve as a managed care organization as defined by 42 C.F.R. 438.2.

Managed care organization or “MCO” shall mean the person, natural or corporate, or any groups of such persons, certified under Public Health Law Article 44, who enter into an arrangement, agreement or plan or any combination of arrangements or plans which provide or offer a comprehensive health services plan, or a health and long term care services plan. “Independent Practice Association” or “IPA” shall mean an entity formed for the limited purpose of contracting for the delivery or provision of health services by individuals, entities and facilities licensed and/or certified to practice medicine and other health professions, and, as appropriate, ancillary medical services and equipment. Under these arrangements, such health care Providers and suppliers will provide their service in accordance with and for such compensation as may be established by a contract between such entity and one or more MCOs. “IPA” may also include, for purposes of this Agreement, a pharmacy or laboratory with the legal authority to contract with other pharmacies or laboratories to arrange for or provide services to enrollees of a New York State MCO.