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Managed care organization services

All certified managed care organizations (MCOs) must offer the following services:

A panel of providers that meets access and coverage requirements

A quality assurance program for monitoring medical care provided to enrolled workers by the MCO's panel of providers

A service utilization review program to ensure enrolled workers receive medically necessary and appropriate medical treatment and to prevent inappropriate or excessive treatment

A peer review program to evaluate and review the medical treatment provided to enrolled workers to ensure it is medically necessary and appropriate and to prevent inappropriate or excessive treatment

A dispute resolution program to resolve complaints by enrolled workers, medical providers, and insurers

A program to promote early return-to-work for injured workers

A workplace safety and health consultation program

 


Questions? Contact us at 503-947-7606 or e-mail wcd.medicalquestions@state.or.us.