Working with MCOs
Oregon laws and rules allow workers' compensation insurers to contract with managed care organizations (MCOs) to manage the medical care in MCO-enrolled workers' claims. MCOs contract with physicians, hospitals, and other providers to deliver quality medical care to workers according to the MCO's treatment guidelines. MCOs educate and support their providers on the workers' compensation system. See below for how the role of MCOs is addressed in state laws and rules.
Please contact the MCO directly for help with:
- Specific treatment guidelines
The MCO enrollment process
A claim can be enrolled in an MCO at any time, but SAIF typically enrolls qualified claims at the time of claim acceptance. SAIF enters into contractual agreements with MCOs to provide medical management according to the Oregon workers' compensation laws and rules. SAIF notifies all known treating providers at the time of the MCO enrollment.
You can also review a claim's status by logging into Business Online, our secure application for medical providers.
How MCOs help
The MCOs role is to review the medical appropriateness, effectiveness, and utilization of the treatment for the claim.
If a provider treating an injured worker is not in the MCO, the worker will need to change to an MCO panel provider, or can request temporary MCO credentialing for that provider. (We will give a list of providers to the injured worker; the MCO's website also has this information).
Oregon workers' compensation rules and laws allow for temporary credentialing of certain types of providers within the MCO, if certain conditions are met. This process is directed by the assigned MCO.
Please send your additional questions about MCOs to email@example.com.