Managed Care Organization (MCO)
The Division of Program Quality and outcomes has branches that oversees managed care organizations (MCOs) to ensure compliance with all federal and state regulations and contract provisions.
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||Available MCO Plans
How to change your Managed Care Organization
Federal regulations allow members to change their managed care organizations outside the 90-day timeline to change. The process is called disenrollment for cause.
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Provider Complaint Form
A provider may submit a complaint form to report issues with one of the Medicaid Managed Care Organizations (MCO). This may include credentialing, claims reimbursement, provider services, etc. For provider convenience a Provider Complaint Form is available and should be completed with applicable information. It may be mailed, emailed, or faxed using information at the top of the form.
Third Party Review Process (SB20)
Senate Bill 20 established the right for a provider, who has exhausted the written internal appeals process of a Medicaid managed care organization (MCO), to be entitled to an external independent third party review of the MCO's final decision that denies, in whole or in part, a health care service to an enrollee or a claim for reimbursement to a provider for a health care service rendered by the provider to an enrollee of the MCO. the legislation also afforded a provider or an MCO the right to an administrative hearing.
907 KAR 17:035 establishes the process for the external independent third party review and 907 KAR 17:040 establishes the process for an administrative hearing.
Beginning with the dates of service on or after December 1, 2016, providers may submit a request for an external independent third party review within 60 calendar days of receiving a final decision from the MCO's internal appeal process. This request must be submitted to the MCO via the contact information on the final decision letter.
Provider Letter #A-102 Senate Bill 20
MCO Contact Information