summer 2019 week 5 233
Unit 5 Assignment – MCO Contract
Submit Assignment
- Due Aug 11 by 11:59pm
-
Points
80
- Submitting a text entry box,
a website
url, a media recording, or afile upload
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.
Rubric
Unit 5 Assignment – MCO Contract
| Criteria | Ratings | Pts | ||||||
|---|---|---|---|---|---|---|---|---|
|
This criterion is linked to a Learning OutcomeContent |
|
35.0 pts |
||||||
|
This criterion is linked to a Learning OutcomeAnalysisPRICE-P |
|
35.0 pts |
||||||
|
This criterion is linked to a Learning Outcome Writing |
|
5.0 pts |
||||||
|
This criterion is linked to a Learning OutcomeAPAPRICE-I |
|
5.0 pts |
||||||
|
Total Points: 80.0 |
||||||||
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