Eligibility and Benefits
The system used to view member eligibility for the state.
What is ePaces?
The system used to view pharmacy rejections and authorization denials.
What is CVS Caremark
The act of complaining to your insurance company regarding any aspect of your health plan.
What is a Grievance?
A request from a member to change the physician listed on their ID card.
What is a PCP change?
TAT to receive an ID card.
What is 7-10 business days?
The 4 plans covered under NY Medicaid
What are MMC, HARP, CHY and EP?
The name of the team who assists with general PA inquiries.
Who is utilization management (UM)?
A member’s request for Molina to review a decision that results in an Adverse Benefit Determinations
What is an appeal?
The information that can be changed during a demographic change.
What is Mailing address and phone number?
Where you go to request member handbooks or policies and procedures.
What is the Molina Store?
The name of the dental vendor for New York.
What is Healthplex?
Certain medical prior authorizations like imaging, special tests and radiation therapy now are outsourced to this company.
What is evicore?
The length of time a member has to file an appeal.
What is 60 days?
Reasons specialist can be added as a PCP.
What is, members having a chronic illness, pregnancy or HIV and AIDs.
Reasons ID cards can be replaced.
What is lost or stolen?
This is where we refer qualified members for transportation assistance.
What is the Medical Answering Service (MAS)?
The length of time all Medicaid and Harp pharmacy authorizations take to process.
What is 24 hours?
This abbreviation is described as the length of time Molina has to respond to an appeal or grievance.
What is TAT?
The date that a PCP change takes effect.
What is the first of the current month, if before the 15th, or the first of the following month on the 16th or after?
TAT for materials to be created in the Molina store.
What is 10- 20 days?
This team assists potential members with general Molina questions.
Who is the NY retention team?
Members considered to be in the Recipient Restriction Program are in what is called:
What is pharmacy-lock-in?
The workflow that provides appeal TAT's
What is the Appeal Quick Reference Guide
Demographics that you cannot change in CRM.
What is member name, ID number, DOB and physical address?
Name three items that members can request from the Molina store.
What are :
Member Handbook
Provider Directories
Evidence of Coverage (EOC)
Schedule of Benefits (SOB)
Outline of Coverage (OOC)
Summary of Benefits and Coverage (SBC)
Drug Formulary
Benefits at a Glance (BAAG)
Forms