What the Heck are the NC MCOs’ Jurisdictions?

Since the new MCO (managed care organization) system is SO new to the Medicaid system in North Carolina (as in since February 1, 2013), I though it would be prudent to explain what the in the heck is the MCO jurisdiction system.

An MCO is defined, generally, as:  a health care provider or a group or organization of medical service providers who offers managed care health plans. It is a health organization that contracts with insurers or self-insured employers and finances and delivers health care using a specific provider network and specific services and products.

In NC, the MCOs are the messengers to the Division of Medical Assistance (DMA)…the middlemen…the ears of DMA.  Instead of 100 separate LMEs, the 11 or so MCOs are supposed to create more of a state-wide, uniform Medicaid criteria.  Now, I am not sure if the below image correctly depicts the jurisdictions of all the MCOs.  It seems as though the MCOs’ jurisdictions change quite often, but the image below is the most current jurisdiction map I could find. Please, if someone else has a more current map, please share.



About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on February 28, 2013, in Division of Medical Assistance, Health Care Providers and Services, Medicaid, North Carolina and tagged , , , , , , . Bookmark the permalink. 1 Comment.

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