This is the largest county by area in which Humana plans are sold in California
What is San Bernardino?
100
This is the department responsible for overseeing the collection and submittal of member health information to CMS for the purpose of generating accurate reimbursement for coverage
What is MRA?
100
This period lasting from October through December where members can elect their health plan is known as AEP, or this
What is Annual Enrollment/Election Period?
100
The Encounters department works most closely with this CA Market department to ensure the proper collection and coding of conditions
What is MRA?
100
This Humana California medical director oversees member clinical outcomes…and also plays a mean round of golf
Who is Dr. McManus?
200
This IPA has the largest Humana membership in 2016
What is PrimeCare?
200
This is the quality rating system to measure Medicare beneficiary experience with their health plans
What is CMS Star Rating?
200
MAPD, one of the plan options for Medicare Members, stands for this
What is Medicare Advantage Prescription Drug?
200
This CA Market department is responsible for handling escalated claims issues
What is Claims Center Point?
200
Although this leader initially went to school to become a pharmacist, she realized that contracting was where her heart was at
Who is Aliza Arjoyan?
300
This term is used to reference ambulance, skilled nursing and surgery centers
What are Ancillary Providers?
300
This is the highest Star Rating possible for a health plan
What is 5 Stars?
300
Also known as a medical group, IPA stands for this
What is Independent Physician/Practice Association?
300
This term is used to refer to a claim paid by an IPA and sent to Humana with patient service data
What is an Encounter?
300
In addition to overseeing MRA, Stars, and Member Experience, this quality initiatives director also devotes her time to being a boy scout leader
Who is Wendy Boggs?
400
For the 2017 plan year, Humana is selling plans in this many California counties
What is 14?
400
ICD-10, the official diagnosis code set for risk adjustment payment, was most recently known as this
What is ICD-9?
400
The department overseeing clinical outcomes is known by HSO or this
What is Health Services Organization?
400
Authorizations and case management notes are entered and tracked in this system
What is CGX?
400
This leader not only manages pharmacy initiatives for CA but also has to oversee her two teenage children when she gets home
Who is Cam Tsaowimonsiri?
500
This term is used to describe the membership threshold required to change from a shared to full risk arrangement
What is Global Trigger?
500
This is the yearly PCP visit that promotes member health
What is Annual Wellness Visit?
500
A key indicator of health plan financial performance, known as MER, stands for this
What is Medical Expense Ratio?
500
These condition codes are used by CMS to determine health status and payment
What are HCCs?
500
This Humana California director's son was a 5 time Jeopardy Champion whose impressive performance landed him in the Tournament of Champions!