Managed Care Operations
Managed Care Operations (MCO) administers Contract Management and Business Operations. Staff are responsible for developing, maintaining and continually evaluating a provider network to ensure adequacy to provide quality services to individuals within the Detroit Wayne system and to provide oversight for contracts as it relates to performance, outcomes and regulatory compliance.
In addition to maintaining the network, MCO ensures capacity at all levels of care including inpatient, outpatient, crisis residential, ACT, and intensive crisis stabilization.
This unit has on-going communication and facilitates education of the provider network including changes in policies and procedures, and new provider orientation.
Additional responsibilities include impaneling of all providers in the Detroit Wayne service delivery system, oversight of the Access Center, COPE (Community Outreach for Psychiatric Emergencies), Department of Health and Human Services (DHHS) Outstation, and numerous specialty program contracts, and claims processing.
As Key DWIHN contact persons, Contract Managers ensure coordination and continuity in contractual interpretations, direction, technical support, monitoring and management of these contracts.
Helpful Links
- Centers for Medicare & Medicaid services, go to: www.cms.gov
- Child Welfare Licensing (MDHHS), go to: www.michigan.gov/mdhhs
- DWIHN Provider Manual
- Department of Licensing and Regulatory Affairs – adult foster care & homes for the aged, go to: www.michigan.gov/lara
- Healthy Michigan plan FAQ (specialty mh/sa carveout, managed healthcare, fee for service information), go to: www.michigan.gov/mdhhs
- How to apply for an NPI number, go to: https://nppes.cms.hhs.gov
- MDHHS Medicaid Provider Manual
- System of Award Management, go to: www.SAM.gov
- Provider Information Change Form