Payer Types
Medicaid Managed Care Organization (MCO)
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Medicaid MCO prior auth answers to three masters: federal rules, state contracts (often stricter), and program-specific protections like EPSDT for children. Multi-state MCOs therefore run a matrix of SLA and notice configurations, which makes centralized, per-state-configurable UM tooling valuable.