Provider Search/PCP Changes

PVL

100

What is located on the bottom of the PVL

The Counties

200

What is in Column H of the Provider Verification List?

Medical Groups

300

What is the time-frame of verification that you should be looking for before you have to call the office?

30 days

400

What can you do to narrow down your options on the PVL?

Filter it!

500

A member in Sacramento County called in to find a doctor for their child in Elk Grove. Who would you refer them to?

Saied, Rahat - Pediatrics

Site Code:

X1C027

LA9312

COMPASS/PCP Change

100

What tab is the current PCP under?

Member Info

200

What is the task for changing the PCP?

Provider Lookup

300

Log into Live COMPASS, tell us whether the member is Capitated or FFS?

Fee For Service

400

How would you find out if a members PCP is Capitated or Fee For Service?

 [+Add Task] Provider Lookup --> HMO 

Enter the ID Number if its only 3 characters add 3 0's

SPS State --> SSB --> Hit Submit

Wait for the search results --> click the drop down arrow

Click HMO --> HMO Products --> Contract Information

PRODUCT DESCRIPTION SHOWS WHETHER IT IS FFS OR CAPITATED

500

Log Into COMPASS, and find this member a new Family Practice PCP in Glendale. What is the site code?

Flores, Louis - 7HF272

Pardave, Raul Arturo - X6W357

Anthem Website

100

What is the Anthem Website to find a PCP?

anthem.com

or

https://mss.anthem.com/california-medicaid/care/find-a-doctor.html

200

Which hyper link would we click on when we get to "Find a Doctor" ?

Search for Medi-Cal Providers

300

What piece of information do we need from the member to locate a doctor near them?

We need the members Zip Code

400

If the doctor that populates name is too hard to pronounce, what can you do instead?

Go to the next doctor or spell it out

500

A member calls in and is looking for a female heart doctor in Zip Code 90005. Who would you refer?

Seogeun N Hong, MD

Faye M M Montegrande, MD

Debra R Judelson, MD

Jessica L Weiss, DO

KM

100

The nickname for the Knowledge Management?

The source of truth.

200

What KM was used for our teach-back?

PCP Changes - Medicaid

Change a Member's Primary Care Physician (PCP) - Medicaid

300

Where would you find the reference guide for exceptions? Show us.

Under California

Are there additional PCP change steps for this market?  

• Medi-Cal Members: 

 For detailed specifics on PCP changes and exception rules please review link

400

How can you find the template and who do you send the email to?

PCP Changes - Medicaid

[e-mail]

500

What is Step 5 on the Help a Member Find a PCP?

5. Complete the search criteria desired based on the following fields for a Non-specific provider search:

(Note: Non-specific provider searches are unavailable for WGS markets.)

• Provider Type: Practitioner, Facility, Group, or IPA (Independent Physician Association).
• Practitioner Type: Must be PCP.
• Service: (optional criteria) Type the first few letters of the medical specialty to select the service needed.

Note: You must choose from the list provided.

• Status: Must be In-Network
• Provider Gender: (optional criteria)
• Provider Language: (optional criteria)
• Distance from member: Distance is calculated from the center of the member’s home zip code, not their physical street address. Coaching tips should be noted as not to exceed specified limits.
• Effective Date: Must be a date member is active in order to complete search. Can be a future date.

Note: Consult market specifics for PCP change effective date field.

• Use Member Home Address: To search for a provider in a specific zip code or specific street uncheck box and enter desired criteria

Fun Round

100

Where did Josie go for her Hot Girl weekend?

LA

200

Where is Chris on Sunday's?

Praising the Lord!

AMEN. 

300

What's a word that you don't want to call your man because you might end up between the washer and dryer?

SASSY

400

What is LC's favorite Cruise Line?

Carnival

500

What does Jasmine name all of her dogs after?

Liquor.