Managed Care Organization Oversight
Improve care, integrity and compliance through effective oversight.
As a trusted provider of Managed Care Organization (MCO) Oversight, HORNE helps states monitor MCO reporting, claims and accounting to ensure their alignment with state and federal contract requirements. With a focus on contract compliance, we strive to help agencies strengthen oversight and ensure accurate reporting. In this vital role, our goal is to improve quality of care, ensure access, promote compliance and support the cost-effective use of resources.
clarity & structure FOR a complex ecosystem
Our goal is to build agency confidence in oversight processes, enhance stakeholder collaboration, and ultimately ensure that beneficiaries receive the right care, at the right time, from the right provider—because effective oversight isn’t optional—it’s essential to improving lives.
MCO Oversight Services
Our team has extensive experience virtually every area of MCO oversight functions such as audits and agreed-upon procedures. Our services include:
- External Quality Review Organization (EQRO) services
- Audits conducted in accordance with Government Auditing Standards
- Agreed-upon procedure reports and engagements in accordance with specified guidance
- Claims Review and Auditing
- Compliance & Regulatory Oversight
- Billing and Contract Compliance
- Performance Audits
- Pharmacy Benefit Manager (PBM) Compliance
- Financial Statistical Report Audits
- Financial and Special Purpose Audits
