Acronyms
What does PCP stand for?
Primary Care Physician
True or False: Member plan product that reflects Dual or Non-Dual STAR Kids only receive SSI and are enrolled in a state waiver program.
False: Plan product reflecting Dual or Non-Dual STAR Kids receive SSI and are NOT enrolled in a state waiver program.
Note: Refer to CTD pg. 47
What is the copay and deductible responsibility for members under the STAR Program?
What is the name for the Texas pharmacy carrier?
Carelon RX
What does DMO stand for?
Dental Management Organizations
Under this plan product what are some examples of urgent medical care?
Minor burns or cuts • Earaches • Sore throat • Muscle sprains/strains.
If member calls stating, they have lost their medication. Where should the OCS transfer the call to?
Carleon TX Technical help desk # 1-844-367-6114
What does FFS stand for?
What is FFS?
Fee-for-Service
Traditional Medicaid and will be disenrolled from MCO.
What is a service that does not require a referral but will need a pre-approval?
**Bonus Question for 100 points**
Name at least 2 services that do require a referral.
Behavioral Health Facility
PT/OT/ST, Specialists
For providers/pharmacy requesting authorization or status on Medical injectables (J or Q codes). Where should the call be warm transferred to?
pharmacy internal ext. 999-888-2214 or 1-844-367-6115
What does FPIL stand for?
Federal Poverty Income Limits
What are the dental plans available to children, teens, and adults aged twenty or younger?
DentaQuest 800-516-0165 • MCNA Dental 800-494-6262 • UnitedHealthcare 877-901-7321
What is the OIG Lock-in Program?
A program that restricts, or locks in, a Medicaid member to a designated pharmacy.
Note: Refer to HCMS Training Doc.
In what circumstances will Carelon (pharmacy dept) override a member to obtain a medication from a pharmacy that is not their designated lock-in program?
Member moved out of geographic area (<than 15 miles for lock-in pharmacy)/Lock-in pharmacy does not have the Rx and not available for < than 2-3 days/Lock-in pharmacy is closed and member need Rx urgently.