Managed care contracts allow the provider and managed care organization to create a relationship
MCO Contract
Managed care contracts allow the provider and managed care organization to create a relationship that defines the rights and obligations of each party. Examples of managed care organizations include HMO, PPO, and POS.
Instructions
Select one managed care organization and create a two-page hospital inpatient managed care contract. The contract can be written from the perspective of the MCO.
Your contract should address information from a minimum of 5 of the following areas:
Reimbursement levels and parameters
Administrative cost criteria
Provider cost and responsibility
Volume
Risk assumption criteria
Claims payments and eligibility determination
Eligibility determination and prior authorization
Dispute resolution
Contract Termination
Provide a detailed explanation stating how each of your selected criteria should be written to protect the MCO.
Submit both parts of this assessment in the same document.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Answer preview to managed care contracts allow the provider and managed care organization to create a relationship
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