PM 20-24-07: MCO - Payment

WAG 20-24-07

Revised Text.Healthcare and Family Services (HFS) pays the Managed Care Organizations (MCOs) a set monthly amount for each enrolled customer, called a capitation payment. This capitation payment covers all the services the MCO provides. HFS does not pay a provider who is not in the MCO and who provides a MCO covered service to a MCO customer. In such cases, providers must seek payment from the MCO. All provider complaints about a MCO must be processed in the Provider Resolution Portal at: Managed Care Provider Resolution Portal | HFS (