A Managed Care Organization (MCO) contracts with providers to create provider networks that deliver health care services at discounted rates. The plan accessing the provider network may offer a Coverage Agreement issued by the MCO. In the alternative, the plan accessing the provider network may be a self-funded plan offered by an employer that contracts with the MCO to access the MCO’s network to apply its discounted rates to the self-funded plan’s Coverage Agreement. Providers are either reimbursed by the MCO’s plans or by the self-funded plans accessing the network and offering benefit plans to employees.

Providers assume the MCO…

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