Managed Care Organizations or “MCOs” means pharmacies, managed health care organizations, group purchasing organizations, large employers, long-term care organizations, formularies, insurers, government agencies and programs (e.g., Medicare and the VHA and other federal, state and local agencies), or similar organizations.
Managed Care Organizations. "MCOs" means Medicaid managed care organizations a certified health maintenance organization (HMO) that provides health care services to Medicaid members pursuant to an agreement or contract with the Bureau for Medical Services.
Managed Care Organizations or “MCOs” means the entities under Contract with the Agency to manage Medicaid services for identified individuals, which are, as of December 2016, Amerigroup Iowa, Inc., AmeriHealth Caritas Iowa, Inc. and UnitedHealthcare Plan of the River Valley, Inc.
Examples of Managed Care Organizations in a sentence
Documentation supporting requirements included in the Information Systems Capabilities Assessment for Managed Care Organizations (ISCAs).
Select one: The State does not contract with MCOs, PIHPs or PAHPs for the provision of waiver services.The State contracts with a Managed Care Organization(s) (MCOs) and/or prepaid inpatient health plan(s) (PIHP) or prepaid ambulatory health plan(s) (PAHP) under the provisions of §1915(a)(1) of the Act for the delivery of waiver and other services.
The State contracts with a Managed Care Organization(s) (MCOs) and/or prepaid inpatient health plan(s) (PIHP) or prepaid ambulatory health plan(s) (PAHP) under the provisions of §1915(a)(1) of the Act for the delivery of 1915(i) State plan HCBS.
Managed Care Organizations shall have a fully executed contract with the Tennessee Department of Finance and Administration.
Managed Care Organizations may not offer incentives such as a greater variety and/or quantity of health care services and benefits as a means of promoting enrollment in their respective plans.
More Definitions of Managed Care Organizations
Managed Care Organizations means the health plans under contract with DHS to provide covered services to Medicaid beneficiaries through the Medicaid/NJ FamilyCare program and that will be directed to distribute Medicaid managed care rate increase payments to hospitals under the County Option Program.
Managed Care Organizations means pharmacies, pharmacy benefit managers, managed health care organizations, group purchasing organizations, large employers, long-term care organizations, formularies, government agencies, and programs (e.g., Medicare and the VA), or similar organizations.
Managed Care Organizations. "MCOs" means Medicaid managed care organizations
Managed Care Organizations. Where the Resident enrolls in or switches the Resident’s enrollment to any managed care organization (hereafter “MCO”), including MCOs that provide Medicare or Medicaid benefits, the Resident agrees as follows: • The Resident shall advise the Home prior to enrolling in or switching the Resident’s enrollment to any MCO. • The Resident acknowledges that the Home is not responsible for and has made no representations regarding the actions or decisions of any MCO with which the Home is a participating provider, including decisions relating to a denial of coverage. • The Home will accept payment from the MCO as payment in full only for those services and supplies covered by the MCO. The Resident is responsible for any co-payments or other costs assigned to the Resident under the managed care plan, or not covered by the MCO under the terms of the managed care plan. If the Resident utilizes services which the MCO refuses to pre-authorize, the Resident shall pay the Home for those services. Further, the Resident shall pay the Home for services for which the MCO has denied payment because the Resident failed to supply information to the MCO, or for services which are denied subsequently by the MCO. • The Home is not obligated to be a participating provider in any MCO. In addition, the Home reserves the right to withdraw as a participating provider in any MCO at any time and for any reason. In the event that the Home withdraws as a participating provider, the Resident may convert his or her coverage to a health plan in which the Home is a participating provider. Effective the date of the Home’s withdrawal from the Resident’s MCO, the Resident is obligated to pay for services and supplies provided to the Resident as a private pay resident. If possible, the Home will provide the Resident with thirty (30) days advance written notice of its withdrawal from the Resident’s MCO. THIRD PARTY PAYMENTS ELIGIBILITY FOR THIRD-PARTY PAYMENTS: Resident may be or may become eligible to receive financial assistance, reimbursement, or other benefits from third parties, such as private insurance, employee benefit plans, Medical Assistance under the Pennsylvania Medical Assistance Program, Medicare benefits, managed care coverage, supplementary medical or other health insurance, supplemental security income insurance, or old-age survivors’ or disability insurance. It is the responsibility of the Resident and/or Representative to apply for these benefits. If Resident is or becomes elig...
Managed Care Organizations has the meaning ascribed to it in Section 2.1(b)(ii) of this Agreement.
Managed Care Organizations means health maintenance -------------------------- organizations, networks of healthcare providers or other similar entities that provide, or otherwise make available, a program of health care services to a member/subscriber for a fixed fee.
Managed Care Organizations. Each managed care organization participating in Connecticut’s HUSKY, Part A managed care program is responsible for ensuring that children enrolled in the plan receive periodic screening examinations and all necessary diagnostic and treatment services in a timely fashion. Responsibilities include, but are not limited to requirements that managed care organizations: • Inform families about EPSDT and its services and the importance of EPSDT services for their children’s health and well-being; • Conduct outreach to ensure children receive EPSDT services; • Link children to primary care providers and dental providers; • Schedule appointments for children for comprehensive EPSDT screening examinations in accordance with the EPSDT periodicity schedule, for necessary interperiodic exams, and for vision and hearing services when medically necessary; DRAFT • Remind families when EPSDT exams are due and follow-up on missed appointments. • Ensure that primary care providers participating in the HUSKY, Part A managed care program are knowledgeable about the requirements of the EPSDT program and that the providers provide comprehensive screening exams, diagnosis, and treatment in accordance with EPSDT requirements.