eligibility
what establishes member eligibility?
county social services office
what services to medical cover at no charge to member?
IN person ASL interpreters
translation services
a ride to the dental appointment or pharmacy
California advancing and innovating medical ( CalAIM) incentive payments are made to fee-for- services providers when?
Once a week as part of a weekly check write
CRA stands for?
caries risk assessment
F3
how can providers verify eligibility?
by calling AEVS hotline
online using the medical provider portal
which CD-MMIS screen should you access to HIPPA verify a member?
FAME INQUIRY SCREEN 14+10
a CSC agent, Care coordinator, and/or a members healthcare plan do transportation vendor to schedule a ride for a member?
yes, absolutely
what does DCN, OHC, and/or MCP stand for?
Document control number
Other health coverage
managed care plan
a member or provider may call in for history information?
yes, absolutely
pregnant members, regardless of age, aid code and/or scope of benefits, are eligible to receive all dental procedures listed in the manual od criteria (MOC) if criteria met ?
very true
members whose income is more than the medical limit for their family size may have a ___________.
Share of cost
what type of transportation assistance for covered by medical?
non-medical transportation (NMT)
non-emergency medical transportation (NEMT)
policy code for 36 ?
authorization disallowed: patient did not appear for a clinical screening
denied claims for prophylaxis, fluoride, and periodontal procedures are not counted as history and do not impact frequency limitations?
what does BIC mean ?
Benefits Identification card
share of cost is an _______ amount established by the county office.
monthly
customer service, (CSC) agent determines member eligibility and provides their eligibility status?
False, we do NOT determine eligibility
what does NOA stands for ?
Notice of authorization
From the HCC inquiry, which key(s) allow you to go to the members Claim/TAR index?
f2
who assigns the BIC number to medical members?
State of California
how can providers check a members remaining share of cost amount?
by calling AEVS hotline
online using the medical website
you receive a call from a member requesting benefit information, before discussing covered services you should:
look up the members aid code
look at the current month's eligibility status in FAME
stop and tell a member with a dental MCP to direct all questions to that plan
what does CIF stand for?
Claim inquiry form
a member may initiate a state fair hearing when they are dissatisfied with ___________
(3 things)
the result of their Quality-of-care complaint
the denial of modification of services submitted on a treatment authorization request (TAR)
the result of their retroactive reimbursement(Conlan) request