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MCO Single Case Agreements
Single Case Agreements (SCAs) are used when an out-of-network provider, which has no contractual agreements with an MCO, is either already in the process of delivering medically necessary emergency care or being considered for the provision of specific predefined services.
MCO CMs in concert with their HCM counterparts are an integral part of identifying opportunities for and formulating SCAs. These agreements are frequently developed through a combination of conference calls and electronic exchanges between the MCO and provider representatives.
[Reference: MCO Continuum, Module A, Prior Authorizations]