This term shows the process of creating and maintaining the most accurate list possible of all medication a member is taking.
What is medication reconciliation?
100
This is the section in Aerial which provides a member’s claims history.
What is the Health Summary?
100
The name of the report where the average abandoned calls are located.
What is the Aceyus report?
100
A member who’s feeling “BLUE” is referred to this person.
What is a BH referral?
100
Name the company that provides our DME to members.
What is Edgepark?
200
The length of time from discharge that a clinician has to complete medication reconciliation.
What is 14 days?
200
Essentials of case management are: Assessment, Planning, __________ , Coordination, Monitoring, Evaluation, Outcomes & General.
What is Implementation?
200
The targeted percentage for the average abandoned call.
What is less than 3 percent?
200
When the member obtains all of his/her care with BCBSIL, except specified external vendors, it is considered this.
What is a carve out?
200
This is the process of confirming dosages’ and scripts.
What is medication reconciliation?
300
The dollar amount each member can take for medication reconciliation.
What is $1000?
300
An outreach program that provides claims resolution to members who are dealing with a loss of a loved one.
What is Seasons of Life.
300
The term that refers to an ID that categorizes a call.
What is Call Type?
300
This is the minimum amount of time a clinician can look back in the member’s history to take a claim for cost savings for no readmissions or ER.
What is 3 months?
300
Accenture, AT&T, Office Depot, Kraft and Northern Trust have this in common.
What is the Blue Focus Team?
400
The length of time from discharge that a clinician has to complete medication reconciliation.
What is 14 days?
400
This was the first planet to be discovered using the telescope.
What is Uranus?
400
The term that refers to the clinician receiving the right calls.
What is Call Skill?
400
This is the person to whom you refer when your program has been opened greater than 6 months.
Who is the Medical Director.
400
This is what you do when working on a program that meets the high dollar mark.
What is “don’t close” or What is “keep open”?
500
The term that demonstrates savings as a result of the case manager's ability to facilitate a negotiated rate lower than the contracted/quoted expected rate.
What is vendor negotiation?
500
The duty “To promote good and be the patient’s advocate” refers to _____.
What is beneficence?
500
How often can you get Aceyus reports and how do you request the frequency?
Anytime with the Aceuyus Tool
500
According to URAC standards, this is the length of time you have for a follow-up call.
What is 30 days?
500
A way to identify an alternative to services that are not covered by the members self-funded benefit plan.