Cultural attributes of our Associates that drive and differentiate MCOcare as a Health Care provider.
Our goal is to provide health care services/programmed that meets our member’s needs and assist them to maintain and improve their health.
We have developed a focused quality program that strives to continuously improve the care and services for our members.
Doctors and Providers (Medical Centre)
We carefully evaluate our doctors and providers, before they see our Members, by reviewing their history of patient care, their licensing and accreditation, and their facilities.
After they’ve joined the MCOcare Health Care network, we continue to evaluate them regularly, looking at the care they provide to our Members and inspecting their offices to make sure they meet all the rules for access, safety, and medical records.
Besides reviewing the Provider’s medical records, we also look at any concerns or problems of our Members may have with any health provider.
We emphasize on the Specialists who attend to our clients registered in National Specialist Registry (NSR), this to ensure the care and service our Members received at the highest accepted standard.
Our Member Services department takes calls from Members to help address any issues they may have with doctors or clinics / hospitals.
We want our Members to have the best care possible.
We have developed several programs to help improve our Members' health.
We collaborate with our Members and their doctors to help manage their health, deal with chronic conditions or diseases, and ensure access to needed health services.
Quality of Service
We constantly monitor how well our Member Services staff answers Member phone calls, and how thoroughly we address member’s questions or concerns.
We make sure we respond to Member requests in a timely manner.
And above all, we want to ensure that our Members are treated courteously and respectfully by our providers.
We are committed to partnering with our Members on their journey to a healthy, fulfilling, and meaningful life.
The Care Management will be comprised of the following areas:
- Pre-service determination
- Concurrent Review, including skills and hospital’s facilities
- Disease Management
- Medical Cost Containment
Care Management's normal business hours are 9:00am - 6:00pm, Monday - Friday. These hours are for processing routine authorization requests and other care management functions.
Clinical Criteria for Care Management Decisions
MCOcare utilizes nationally recognized criteria to determine medical necessity and clinical appropriateness.
Criteria may also be developed by MCOcare based upon a review of literature and government regulations.
The Medical Advisory Committee, consisting of practicing physicians, approves all criteria annually, or as indicated.
Criteria utilized are consistent with clinical practice guidelines.
MCOcare adapts procedures for applying criteria to meet individual Member needs and local medical practice.
The Provider Manual includes the criteria being utilized.
Practitioners may also request the criteria from the Care Management Department.
MCOcare’s Medical director is available during normal business hours to discuss a denial case with the treating or attending practitioner and can be contacted by calling the Care Management department number above.
MCOcare offers a medication therapy management (MTM) program at no additional cost to Members who have multiple medical conditions, taking many prescription drugs and have high drug costs.
The program was developed and is maintained by our pharmacy benefits management partner (PBM).
The PBM employs pharmacists who review prescription records for all of our Members looking for opportunities to improve.
We use the program as an added value service for our Members.
For example, MTM helps us make sure our Members are using appropriate drugs to treat their medical conditions and helps us identify possible medication errors.
If problems are encountered, the information is shared with our Case Management staff Members who will try to assist.
MCOcare Disease Management Program is a free program designed to help Members stay healthy while keeping their chronic conditions under control.
Our dedicated nursing staff contacts and educates Members, helping them take the steps needed to maintain a healthy and fulfilling lifestyle.
MCOcare dedicated team of nurses accomplishes this by reinforcing proper treatment plans and educating Members about their conditions.
This typically incudes information about:
- The early signs and symptoms of sickness
- Medications and its administration
- Healthy dietary life style
- Managing and maintaining scheduled doctor visits
- Issues regarding Hospital admissions
The main goal is to empower the Member to take control of their illness and remain healthy.