General
Claims
PRO
QM
Mixed Bag
100
The building with trees as conference rooms
What is building 840?
100
A high-speed automated process in which machine printed (and sometimes hand printed) words, letters, numbers and symbols are recognized and translated into computer processable information
What is Optical Character Recognition (OCR)?
100
A technology-based information system, used by the PRO, that uses established databases to capture, track, and trend customer information from start to finish
What is Customer Relations Management System (CRMS)?
100
The record type for a defect in Production
What is a Problem Statement?
100
The application where the MMIS tables are located
What is the Time Sharing Option (TSO)?
200
The length of this CA-MMIS contract
What is 10 years?
200
Information necessary for proper adjudication of claim service line items
What are Edit Criteria?
200
Senate Bill 335 Imposed a fee on certain general acute care hospitals in order to make supplemental and grant payments and increased capitation payments to hospitals up to the aggregate upper payment limit for the period of July 1, 2011 to December 31, 2013
What is the Quality Assurance Fee (QAF)?
200
The record that is submitted to close a Problem Statement
What is a Correction Notice?
200
Scanning and Key Data Entry
What is the Front End Entry Department?
300
The action DHCS takes when they believe a part of the contract is out of compliance
What is a Corrective Action Plan (CAP)?
300
The coding structure used in the Medi-Cal Program for identifying a diagnosed medical condition
What is International Classification of Diseases-10th Revision-Clinical Modification (ICD-10)?
300
Serves as a centralized focal point of contact for Audits and Investigations, Federal Bureau of Investigations, Department of Justice, and FICOD staff, to request provider and beneficiary claim information as it relates to the detection of fraud and abuse within CAMMIS. The unit assists both Department and external staff in identifying and taking action against those providers suspected of defrauding the Medi-Cal Program
What is the Provider Relations Unit (PRU)?
300
The type of analysis based in quantities
What is quantitative analysis?
300
A graphical presentation that provides users with insight into the performance metrics and key performance indicators, crucial for effective decision making
What is a dashboard?
400
The term for the current CA-MMIS system
What is Legacy?
400
A claim billed to Medi-Cal for the Medicare deductible and/or coinsurance. This type of claim has been approved or paid by Medicare
What is a crossover claim?
400
This is aimed at increasing the rate of health insurance coverage for Americans and reducing the overall costs of health care
What is the Affordable Care Act (ACA)?
400
The document that describes the internal quality pocedures and standards
What is the QAPSM?
400
The name of the application used by PRO to document issues and create service requests
What is Customer Relationship Management (CRM)?
500
The formal means of communication used in the CA-MMIS contract
What is a Fiscal Intermediary (FI) Letter?
500
The number of days by which 100% of clean claims need to be processed
What is 45 calendar days?
500
PRO departments
What are TSC, CMC Helpdesk, RAU, and CSU?
500
The record that is submitted to close an EPC
What is a Completion Notice?
500
What are the 5 QwikSolver phases?
What are Define, Measure, Analyze, Improve, Control?
M
e
n
u