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.