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 use your own words.