1 Point
1 point per question
Where can you locate the HCE in Dynamo?
HCE is also known as ____ ?
Complete at least which module initially ?
HCE stands for what?
Why is it so important to address member's HCE
Purple sheet # 12. Overlay HCE Tab
SDOH ( Social Determinants of Health)
Education module
Healthcare Equity
systematically identifying and eliminating inequities resulting from differences in health and in overall living conditions.
Go to Dynamo and demo how to set-up episode page
# 11. Alerts, Special Interests Subgroups, Cond/Dx of Interest, Vulnerable
Demo : Link a Document in dynamo ( HCBS Needs Tool December 2024)
# 40 Purple sheet
When you revised the Care Plan for the Interval assessment where do you put this information on the Care Plan ? Show us in Dynamo
Who should you share the Care Plan with at a minimum ?
Go to dynamo and share the Care Plan using today's date for the Mbr & PCP.
Mini event
QNXT PCP & Member
Always share the CP when you revise it.
Where can you find MI advance directives?
Where can you locate the BH consent form to send to the member?
If the Member has a PIPH claim in CC360 what does this mean?
IST stand for what and when is this completed?
Both answers Michigan requests at the bottom of the purple sheet
CM would choose yes for BH assessment to be completed.
Initial screening tool
Member completed an Initial Screening Tool (IST) which purpose is to identify members with immediate needs to prioritize the member Level 1 V2 Assessment. Best efforts to complete IST would be made with 15 calendar days of Enrollment
When should the CM make their first call attempt to the member after the member has been discharged from the hospital?
If a PCR member is UTR during the confinement call what do you do?
Within 24 hours from D/C date
F2F visit in the hospital
Regarding the Care Plan letter for the QNXT Primary Care Doctor what must you member to put in the title?
PCP Care Plan Letter
Welcome Provider letters are sent to whom?
How Often?
QNXT PCP & Member
Annually
HCBS needs tool if over 20 hours per week of PCS what do you do?
T or F
if a member qualifies (NFLOCD) under door 1 then I also, have to qualify them under door 2.
Where is the NFLOCD tab located in dynamo?
Get the Manager to approve
False is they qualify under door 1 then you will stop no need to go any further.
L1V2
What do you check on the Care Plan on the Safety Action for Crisis/Emergency ?
911 & go to ED only
If your member is population health how often should an interval assessment be completed?
What stratification is Population Health?
What are the ICM stratification levels:
LTSS stratification levels:
Every 180 days
Low
High, Supportive, Low
High & Supportive
Where can you locate the condition specific assessments (CSA) ?
Name the 6 Hedis(Dxs)
Which assessment should you do for the CM safety prior to the F2F visit?
Under evaluation tab in dynamo
DM, COPD, CAD, Depression, bipolar, HTN
# 22. Safety Questionnaire
Where can I locate Silver Sneakers information to send to the member?
Purple sheet/ click on the Michigan Requests link
Demo in Dynamo: Send a Task to Toni to remind her to f/u with the member regarding his new glucometer?
# 42
Demo where you can locate the Stratification/Score ?
How often do you review the Stratification/ Score on your members?
Does the member preference section on the CP has to be completed? If so, what status do you leave it in?
Episode page. Monthly at a minimum.
Purple sheet # 23
How often should you check the CM dashboard?
The coming due date for an assessment on the DB will be listed how many days in advance?
CTP for BH/ Region 7 demo
Daily
90 Days
# 7
You should begin the Member's long term goal with ___ on the Care Plan.
with an " I"
Demo: CMAT for MFR
# 3
Demo CTP event for QNXT Dr. Elizabeth Smith PCP
Purple sheet # 9 Go to dynamo and set-up member has no guardian
# 7
# 9
Complete an AD event?
What is a TPA and what's the expiration on the TPA?
The HIPAA event is go for how Long?
Go to dynamo and complete HIPAA event.
# 29
1 year // check QNXT
Only that call
Do a Placement event in Dynamo?
Do you leave this type of Placement event for PCS in the open or closed status? Explain
# 14 Purple sheet HCBS Services
keep Open until services are terminated
Go to the Interval assessment in Dynamo and show that it's completed in the member's Journal
Tell me about the IA?
When is this assessment completed?
What goes under the RIOP (text box) for an IA CMAT?
Overlay evaluations; Journal
Based on stratification levels
NCQA Monthly template
How many member contact attempts by the CM are needed for the initial Level 1 V2/HRA outreach ?
If I call a member on Monday at 9 am and then call again on the same day at 3 pm, then how many attempts is this?
5 attempts or 4 phone calls and 1 utr letter
The drive by cold call is after the 4th UTR call but does not count as an outreach attempt. If drive by is still UTR a 5th and final call is needed.
- Only one call attempt is allowed on the same day
Before You do a Comprehensive assessment what must be listed on the episode page?
What must you check on the episode page before doing condition management?
What's the status for condition management and why?
Go to dynamo and Set up condition management for COPD
Must have Program Type on the episode page
Conditions/Dx of Interest # 13
# 34 Managing
What is a CSA?
Before completing CSA what must you check?
Explain the PDQ process?
What do you do if a mbr has a QNXT claim for Dx and declines to work on this Dx with you?
What do you do if a mbr states they are working on this Dx with their PCP and decline to work on this Dx with you?
Go to Dynamo and demonstrate the above .
Condition Specific Assessment
QNXT claim
MFR
Call member: 1st attempt within 24hours/ 2 more attempts
update CP GAI and intervention must include the admission date
Share CP with PCP & Mbr
Call PCP and schedule f/u visit 7-10 dates after d/c date
send CP letters
Complete CMAT