What is the difference between an MCO and a TPA? What does each do for injured employees?
An MCO is a Managed Care Organization that arranges for the provision of medical and health care services for injured employees. The MCO is responsible for handling all matters related to medical treatment. A TPA is a Third Party Administrator hired by a self-insured employer like CCSD to provide administrative services and manage workers compensation claims. The TPA is responsible for claim investigation, claim acceptance, claim closure, and other matters related to claim administration. The MCO assists the injured employee with obtaining quality MEDICAL services. The TPA evaluates claims for coverage applicability, monitors progress, assures timely and accurate payments, and all other claim ADMINISTRATION functions.
