Enrollment in a Managed Care Organization
What is a managed care organization?
A managed care
organization (MCO) is a group of medical providers who have obtained
certification from the Workers’ Compensation Division. The MCO contracts with
insurers to manage and provide medical care to workers with work-related
I received a letter from my insurer enrolling me in
a Managed Care Organization. What does this mean?
employer is covered by an insurer who has contracted with a managed care
organization (MCO), the insurer may enroll you in an MCO at any time after your
injury. The insurer must provide you with a written notice of enrollment that
contains all required enrollment information, and includes either a written
list of the MCO's eligible attending physicians or a Web address for you to
access the list.
CareMark Comp MCO (Managed HealthCare Northwest, Inc.):
Majoris Health Systems Oregon,
Inc. MCS (formerly
Oregon Health Systems, Inc. MCO):
Complete Quality Care, Inc. MCO:
Am I required to treat with an MCO panel provider?
Until you are
enrolled, you can treat with any health care provider who qualifies as an
attending physician. After enrollment, if you have a family doctor who
qualifies as a primary care physician or authorized nurse practitioner and
meets certain requirements, he or she can continue to treat you by agreeing to
the MCO's rules, terms, and conditions.
What if my attending physician is not an MCO panel
provider and does not qualify to continue to treat me as a primary care
physician or authorized nurse practitioner?
continue to treat with your non-MCO provider for up to seven days from the
mailing date of your enrollment letter. However, at the end of the seven days,
the insurer will not reimburse the non-MCO provider for medical services and
your time-loss benefits may be suspended, if applicable.
Can I appeal an MCO’s medical decisions?
Yes. If an MCO disapproves a medical service, or you disagree with an MCO decision, you can appeal that decision. The MCO must provide written notice of its decision to all parties and include the process for appealing the decision. When an MCO receives a complaint or dispute that is not included in its dispute resolution process, the MCO must provide you notice within seven days of your right to request review by the Workers' Compensation Division.