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A thoughtful procurement and contracting procedure may additionally help align stakeholder, condition and MCO expectations ahead of the deal starts off, be certain readiness, and prevent later problems. Louisiana’s product contract incorporates in-depth descriptions of the two state agency and MCO tasks in the course of the readiness evaluate system if the condition is deciding whether or not the MCO is prepared to get started on working.
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Indiana now demands its MCOs to write-up certain information regarding prior authorizations on the internet and has advised that an interim committee review regardless of whether health care providers that has a heritage of approvals need to be exempt from Medicaid MCO prior authorizations (in some cases called gold-carding).
Medicaid managed care corporations (MCOs)—non-public business coverage firms contracted through the state to administer the Medicaid software—include close to sixty five% of Medicaid beneficiaries and account for fifty two% of whole Medicaid spending nationally.
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Simply because managed care contracts account for a good portion of point out Medicaid shelling out, states Engage in a important role in developing and overseeing Medicaid managed care capitated payment charges, the per member every month price compensated to MCOs for solutions and administration.
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