summer 2019 week 5 233

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Unit 5 Assignment – MCO Contract

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Managed care contracts allow the provider and managed

care
 organization to create a relationship that defines the rights and obligations of each party. Examples of managed care organizations include HMO, PPO, and POS.

Instructions

  • Select one managed care organization and create a two-page hospital inpatient managed care contract. The contract can be written from the perspective of the MCO.
  • Your contract should address information from a minimum of 5 of the following areas:
    • Reimbursement levels and parameters
    • Administrative cost criteria
    • Provider cost and responsibility
    • Volume
    • Risk assumption criteria
    • Claims payments and eligibility determination
    • Eligibility determination and prior authorization
    • Dispute resolution
    • Contract Termination
  • Provide a detailed explanation stating how each of your selected criteria should be written to protect the MCO.
  • Submit both parts of this assessment in the same document.

Rubric

Unit 5 Assignment – MCO Contract

Unit 5 Assignment – MCO Contract
Criteria Ratings Pts

This criterion is linked to a Learning OutcomeContent
35.0 pts

Level 5

Demonstrates the ability to construct a clear and insightful problem statement/thesis statement/topic statement with evidence of all relevant contextual factors.

 31.5 pts

Level 4

Demonstrates the ability to construct a problem statement, thesis statement/topic statement with evidence of most relevant contextual factors, and problem statement is adequately detailed.

 28.0 pts

Level 3

Begins to demonstrate the ability to construct a problem statement/thesis statement/topic statement with evidence of most relevant contextual factors, but problem statement is superficial.

 24.5 pts

Level 2

Demonstrates a limited ability in identifying a problem statement/thesis statement/topic statement or related contextual factors.

 21.0 pts

Level 1

Demonstrates the ability to explain contextual factors but does not provide a defined statement.

 0.0 pts

Level 0

There is no evidence of a defined statement.

35.0 pts

This criterion is linked to a Learning OutcomeAnalysisPRICE-P
35.0 pts

Level 5

Organizes and compares evidence to reveal insightful patterns, differences, or similarities related to focus.

 31.5 pts

Level 4

Organizes and interprets evidence to reveal patterns, differences, or similarities related to focus.

 28.0 pts

Level 3

Organizes and describes evidence according to patterns, differences, or similarities related to focus.

 24.5 pts

Level 2

Organizes evidence, but the organization is not effective in revealing patterns, differences, or similarities.

 21.0 pts

Level 1

Describes evidence, but it is not organized and/or is unrelated to focus.

 0.0 pts

Level 0

Lists evidence, but it is not organized and/or is unrelated to focus.

35.0 pts

This criterion is linked to a Learning Outcome

Writing
5.0 pts

Level 5

The paper exhibits an excellent command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling.

 4.5 pts

Level 4

The paper exhibits a good command of written English language conventions. The paper has no errors in mechanics or spelling with minor grammatical errors that impair the flow of communication.

 4.0 pts

Level 3

The paper exhibits a basic command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication.

 3.5 pts

Level 2

The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.

 3.0 pts

Level 1

The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.

 0.0 pts

Level 0

The paper does not demonstrate command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty in discerning the meaning.

5.0 pts

This criterion is linked to a Learning OutcomeAPAPRICE-I
5.0 pts

Level 5

The required APA elements are all included with correct formatting, including in-text citations and references.

 4.5 pts

Level 4

The required APA elements are all included with minor formatting errors, including in-text citations and references.

 4.0 pts

Level 3

The required APA elements are all included with multiple formatting errors, including in-text citations and references.

 3.5 pts

Level 2

The required APA elements are not all included and/or there are major formatting errors, including in-text citations and references.

 3.0 pts

Level 1

Several APA elements are missing. The errors in formatting demonstrate a limited understanding of APA guidelines, in-text-citations, and references.

 0.0 pts

Level 0

There is little to no evidence of APA formatting and/or there are no in-text citations and/or references.

5.0 pts

Total Points: 80.0

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