Contract Administration, State Compensation Insurance Fund, Department of Administration : Performance Audit Report 1998

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Contract Administration, State Compensation Insurance Fund, Department of Administration : Performance Audit Report 1998
Montana. Legislature. Legislative Audit Division
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The MCO works with the adjuster to help manage the claim. As with vocational rehabilitation, State Fund focuses on getting the injured worker back to work. Section 39-71-1 101(3), MCA, contains criteria for determining when an injured worker should be referred to an MCO.
Under the current contract, eight managed care organizations provide services. MCO responsibilities under the contract include various duties, but the underlying intent of the contract is to provide medical case management serv
...ices. MCO providers have requirements, by contract, for initial medical examinations, treatment plans, and final medical treatment and reports. The contract includes time frames for completion of certain services, such as referral from an MCO to a Page 12 Chapter II - Background treating physician within seven working days. The contract term is July 1, 1997 through June 30, 1998.
The current contract is a fee-for-service format. Each MCO is paid a $260 fixed fee per wage loss file referred to the MCO.


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