MCP
It is a plan that has no OON benefits and needs referral to visit a specialist.
What is HMO?
This is a plan that does not need a referral and does not have out of network benefits.
What is EPO? or What is Exclusive Provider Organization?
IDs used to search for a member in ESAWS
What are
CIN Number (for Medicaid members)
New Member ID (NMI)
Social Security Number
HIX Number
Does not cover IVF, GIFT, ZIFT, FET or more complex infertility treatments.
What is Infertility Mandate?
A medical condition in which the heart is enlarged. It is more commonly referred to as an enlarged heart
What is Cardiomegaly?
A plan that needs referral from the PCP to see an INN specialist and does not require one for OON.
What is POS? or What is Point-of-Service Plan?
It is a system which provides quality health care while keeping costs down by coordinating or managing services.
What is MCP? or What is Managed Care Plans?
When clicked a screen will pull up where the rider list for that contract as well access a summary document highlighting benefits can be viewed
What is CAT#? or What is spyglass beside CAT#?
Prohibit insurers and HMOs from limiting a woman’s direct access to primary or preventative services or pregnancy related care from a qualified network provider of her choice to less than two examinations per year for most insured groups. Likewise, insurers and HMOs may not limit direct access to follow-up care or treatment that becomes necessary as a result of such examinations or as a result of an acute gynecological condition. |
What is Women’s Preventive Services (WPS) Mandate or Well Woman Mandate?
A medical practitioner qualified to diagnose and treat tumors
What is an Oncologist?
It is a documentation that needs to be approved first before a member can be directed to a specialist.
What is a referral form?
It is a specialist that diagnose and treat hormone imbalances and problems by helping to restore the normal balance of hormones in the body.
What is an Endocrinologist?
This detailed information can be displayed as form view or list view which displays as a single line of data. Provides a snapshot of the Member including full name & address, DOB, PCP, etc.
Buttons at the top of the grid are for Request and Reference Options
The spyglasses, when clicked, will provide additional information (if applicable)
Alerts may appear, providing additional information
What is Member Demographics?
Requires HMO’s and indemnity carriers to provide a minimum of 30 inpatient mental health days and 20 outpatient mental health visits and mandates unlimited inpatient, partial hospitalization and outpatient mental health coverage for large group policyholders for treatment of specific Mental Health biologically based diagnoses and Children with Serious Emotional Disturbances (SED). |
What is Timothy's Law? or What is Mental Health Parity Law?
An enhanced form of x-ray technology that is used to measure bone loss.
What is a DEXA Scan? or What is a dual energy X-ray absorptiometry scan?
It is the entire group of preferred physicians, hospitals and health groups.
What is network providers?
It is a specialist that is concerned with the ear, nose, and throat and their diseases.
What is an Otolaryngologist?
Display any alert that has been setup for the member. Alert Types maybe: Domestic Issues; Identity/ Eligibility issues; Mailing Issues; PCP restrictions; or Member Password Verification.
What is Patient Alerts?
Establishes regulations around a dispute resolution process that holds the members harmless for costs associated with non-emergency services, unexpected bills from non-par providers or "surprise bills"
What is Out of Network (OON) Bill?
The administration of antigenic material to stimulate an individual's immune system to develop adaptive immunity to a pathogen.
What is Vaccination?
It is a medical doctor devoted to the study and medical treatment of disorders of the foot, ankle and lower extremity.
What is a Podiatrist?
It is a specialist that uses hands-on spinal manipulation and other alternative treatments, the theory being that proper alignment of the body's musculoskeletal structure, particularly the spine, will enable the body to heal itself without surgery or medication.
What is a Chiropractor?
Allows the advocate to document inquiries without having to click on the Create SR button and choose a Category and Subcategory. It also allows the advocate to select the Primary and Linked Entities.
What is a Wizard SR?
Covers newborn care, under the mother’s maternity benefit, for the first 48 hours after vaginal delivery and the first 96 hours after cesarean delivery. Allows the member up to 30 days from the baby’s date of birth to enroll the newborn.
What is a Newborn Mandate?
Designed to provide support to the patient and their loved ones during the final phase of life. Focuses on comfort and provides a better quality of life, with the goal to enable patient to have an alert, pain-free life and live each day as fully as possible.
What is Hospice Care?