BCBS Reports
Navigating BCBS Portal
Claims & Utilization
Recap from March
Recap from May
100

How frequently is the Attributed Patients report updated? 

What is Daily? 

100

Where can you find references, release notes, and sources in PCMS? 

What is Quick Links?

100

Are there learning opportunities available for Medicare Risk Adjustment Documentation and Coding Guidance? 

What is YES? 

100

What is the name of the Portal you use to access BCBS?

What is Availity?

100

MRA

What is Medicare Risk Adjustment?

200

What are the 2 gates that must meet a minimum performance threshold on the Medicare Essentials PCMS Performance Scorecard? 

What is Stars Quality measures and Persistent Condition Validation (PCV)?

200

Which ticker on the home page allows you to see the number of patients in your population? 

What is Attribution ticker? 

200

TRUE or FALSE: Attributed patients who have been authorized for an inpatient admission remain on the report from authorized admission to 30 days post discharge? 

What is TRUE?

200

Name one procedure for a gap which is closed without using a CPT II code.

What is Colonoscopy, Osteoporosis, or Mammogram

200

TRUE or FALSE: There does not have to be documentation in the medical record to support the presence of a condition or indicate providers assessment & plan for mgmt?

What is False?

300

Prior to a patients visit which report would allow you to see a patient's open care gaps (i.e. overdue for A1C test)? 

What is Care Opportunities 



or could be seen on an Attribution report

300

What does PCMS stand for? 

What is Provider Care Management Solutions? 

300

Where can you find patients claim activity? 

What is P360?

300

Name 2 methods that can be used to close Colorectal Cancer screening.

What is Colonoscopy, FOBT, Cologuard, or Sigmoidoscopy?

300

Latent autoimmune diabetes in adults

What is diabetes mellitus Type 1.5?

400

On the Attribution report which column would identify a Medicare patients persistent chronic condition for validation in the current Measurement Period? 

What is Condition-Based Opportunities column. 

400

Name the bar graph chart that is displayed on the PCMS Home Page? 

What is Care Opportunity by Condition?

400

Name 2 type of claims that can be found in P360? 

What is Office Visits, emergency department visits, inpatient visits, pharmacy claims, and lab claims? 

400

Name a common diagnosis of a Potentially Avoidable ER visits.

What is UTI, Cellulitis, Hypertension, Pressure Ulcers, or Uncontrolled Diabetes etc.

400

What is diabetes mellitus Type 1.5?

What is True?

500

Name 2 of the reports found under the Population tab? 

What is Attributed Patients, Inactive Patients, Care Opportunities, ER Visits, Inpatient Admissions, Pharmacy or Cost Opportunities

500

Is there an advanced filter in PCMS that will allow for identification of members in need of a Medicare Annual Wellness Visit?

What is YES? 

500

                     DOUBLE JEOPARDY!!!!


Who are the CGMCN Case Managers that will be contacting you regarding Utilization? 

Who is LaTisha & Rebekah

500

What facility does CGMCN prefer for you to refer a patient to who needs Urgent Care?

What is AlphaMed

500

E08, E09, E10, E11, E13

What are the five diabetes mellitus categories?

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