Mississippi § 83-41-403 - Definitions.

§ 83-41-403. Definitions.

As used in this article: “Department” means the Mississippi Department of Insurance. “Managed care plan” means a plan operated by a managed care entity as described in subparagraph (c) that provides for the financing and delivery of health care services to persons enrolled in such plan through: Arrangements with selected providers to furnish health care services; Explicit standards for the selection of participating providers; Organizational arrangements for ongoing quality assurance, utilization review programs and dispute resolution; and Financial incentives for persons enrolled in the plan to use the participating providers, products and procedures provided for by the plan. “Managed care entity” includes a licensed insurance company, hospital or medical service plan, health maintenance organization (HMO), an employer or employee organization, or a managed care contractor as described in subparagraph (d) that operates a managed care plan. “Managed care contractor” means a person or corporation that: Establishes, operates or maintains a network of participating providers; Conducts or arranges for utilization review activities; and Contracts with an insurance company, a hospital or medical service plan, an employer or employee organization, or any other entity providing coverage for health care services to operate a managed care plan. “Participating provider” means a physician, hospital, pharmacy, pharmacist, dentist, nurse, chiropractor, optometrist, or other provider of health care services licensed or certified by the state, that has entered into an agreement with a managed care entity to provide services, products or supplies to a patient enrolled in a managed care plan.