MCO Claims Issues

$30.00


[3578] MCO Claims Issues
What, When, Where, and How to address Provider complaints and inquiries against your Managed Care Organization.


Presentation Info:

  • TAHC&H Event | HCSSA Administrator Conference | Recorded for On-Demand Access
  • Presentation Date | November 17, 2021

Education-Training Credits:

  • TX HCSSA Administrator/Alternate Continuing Education
    • 1.00 Clock Hr(s)

CE Approval Statements:
· This program meets continuing education requirements for Administrators and Alternates under Texas HCSSA licensing regulations.

HCSSA Topic(s) Addressed:

  • §558.259[d][4]agency responsibilities
  • §558.260[a][3]basic principles of management in a licensed health-related setting
  • §558.260[a][7]financial management

Program Description: In this presentation HHSC Senior Manger of Managed Care Compliance and Operations Michael Osborne describes the What, When, Where, and How to address Provider complaints and inquiries against their Managed Care Organization.

TAHC&H Faculty/Presenter(s): Michael Osborne, Sr. Manager, Managed Care Compliance and Operations, HHSC

About the Presenter(s):
Michael Osborne
is the Sr. Manager Managed Care Compliance and Operations for HHSC. He has 25 years of State Service with The Texas Department of Health and the Health and Human Services Commission; 17 years with the Vendor Drug Program, assisting with pharmacy providers with Point of Sale claims and software issues; and 8 years with Managed Care Compliance and Operations, Senior manager of Research and Resolution. Coordinate complaints, from various stakeholders, against the MCOs to ensure the timely delivery of contracted services and benefits to members and reimbursement to the providers.


[3578] MCO Claims Issues

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