State Hearing
What is the formal process a member may request if they disagree with a Medi-Cal Dental decision?
What is a State Hearing?
Which system is used to document member interactions and review case history?
What is CRM
A member expresses dissatisfaction with services received. What should be offered?
What is a Complaint/ greivence?
What keys would I use to navigate FAME.
What would be 10
What is aid code x7?
What is non dental.
How many days does a member generally have from the Notice of Action date to request a State Hearing?
What is 120 days?
How long after services do members have to request Conlan?
What is 12 months/ 1yr after DOS.
Question: Can complaints be submitted verbally/ over the phone?
What is yes, with a TSC agent.
What keys would I enter and where would I be, if I wanted to check member alternate format?
What is 10 and F3 FAME.
What is aid code 0C?
What is HF services only (no MediCal) No Access for Infants and Mothers (AIM) - Infants enrolled in Healthy Families (HF). Infants from a family with an income of 200 to 300 percent of the federal poverty level, born to a mother enrolled in AIM. The infant’s enrollment in the HF program is based on their mother’s participation in AIM.
True or False: TSC agents can decide the outcome of a State Hearing?
Answer: What is False?
What services can members request a Conlan packet for?
What is medi-cal covered services/ any example D????
What should an agent do when a member wishes to file a complaint?
What is gather details and document the complaint? To find out if it's a QOC/ complaint about services or the office/ staff.
How would I fine the member history/HCC?
What is 14+5.
What is aid code 40?
What is Full Scope No AFDC-FC/Non-Fed (State FC). Provides financial assistance for those children who need substitute parenting and who have been placed in foster care.
A member says they received a denial notice and would like to challenge the decision. What information should you provide?
What is information on requesting a State Hearing?
If the conlan request is in the member favor, who would provide the payment to the member?
What would be the provider.
A member says a provider was rude and refused treatment. What type of case may be appropriate?
What is a Provider Complaint and member would have to contact the dental board.
If RTD was sent, what key functions would you use to check the RTD reason?
14+4+FN11/PF11
What is 6F aid code? Is it a benefit?
What is None Yes PERSONAL CARE SERVICES PROGRAM.
What document usually explains a member's right to file a State Hearing when services are denied, reduced, or terminated?
Answer: What is a TARNOT?
Can a member request a conlan packet for covered services preformed outside of the state of CA?
Yes, however medi-cal services are not covered outside of CA.
True or False: Complaints and State Hearings are the same process.
What is False?
Where and would you type to check comments on TAR & NOA?
What is type C in next functions.
What is 7G and is it a benefit?
What is 7G Valid only for ambulatory prenatal care services No Presumptive Eligibility (PE) – Ambulatory Prenatal Care Services (FFP). This option allows the Qualified Provider to make a determination of PE for outpatient prenatal care services based on preliminary income information. 7G is valid for Ambulatory Prenatal Care Services. Persons placed in 7G have pregnancy test