BLAME IT ON THE AUDITOR
Cases are eligible for audit ___ days after opening the CME
what is 30 days?
If we have a known dynamo down time you can do these things (must name 2)
Learning Hub Trainings, success stories, call members from TANF list utilizing qnxt and documenting in word
ps dont forget your system down code :)
CIs have to be entered within this time frame
what is 24 hours of YOU being notified?
Our goal for talk time for annual reviews come winter 2025 is:
what is 20%?
This team lead runs CIs for regions 1/2/DD with Jenna currently
Who is Tina?
PS: The next 2 weeks Pat will be joining!
A member wants to work on their dental issues, access to food, and their weight management. Name a long term goal
What is ________? Answer may vary
ex: I want to work on my health to improve my quality of life
All assessment notes (care plans and NCQA Summaries) must be entered into dynamo within this time frame
24 hours - all non- assessment notes have 48 hours
The CI Cadence (number of calls / letters) to the member is:
4 calls and 1 letter if UTR with documented data mining
or
3 successful contacts with member
This avaya code appears when you do not put yourself in any code
what is available time (aka the peach code is a no go!)
Our ABHIL Interim Director is:
Who is LJ (Lisa Jasmin) Ford?
These two specific SDOH concerns must be addressed in the NCQA / Summary note and also the care plan with a goal if there is a concern
what are food and housing?
Name 2 things that stay in OPEN status in Dynamo
What are: HIPAA EVENTS (only for guardian), HCE Data, Member Preferences, the CME
This goes in the "Immediate Intervention" section of your CI
What are Member safety (if they went IP or were evaluated) and what YOU did?
Can you give an example of this?
This code is what you use for your breaks - but not your lunch
what is not ready?
Our MODIVCARE point of contact at Aetna is:
Who is Sahil Sharma?
These assessments must be completed for anxiety/depression
What is Anxiety V2 and What is Depression V2?
Note: PHQ9, GAD7 are screeners - they are done every 2 months after the complete assessment
When you mail Krames materials out you must complete these two steps
Use Krames Lettterhead to send and also do a materials request
Give 1 example of a PQOC:
May vary - any time we have a concern about a provider's quality of care provided
This avaya code is used for meetings like this current portion of our training
what is Training? Note: Clinical audit prep is for: success stories, town halls, grand rounds, case rounds, and SME Activities
The ABHIL Pharmacy manager is:
Who is Pawel Piechocinski?
Member has Diabetes and Anxiety and does not see a PCP:
Break down the care plan:
Possible Barriers: Strength: Long Term Goal: 1 goal and 2 interventions
I do not have a relationship with a pcp, i am motivated to make decisions regarding my health, i want to control my diabetes, 1. I will work with my pcp to better manage my diabetes: 1. i will establish with a pcp 2. i will take medications as prescribed
With the new interval contact you send a letter when
what is when a member doesnt answer the 2nd call and doesnt have a voicemail setup?
A member is a 43 year old female TANF member who reports to you that she is concerned that her daughter is stealing money from her bank. Do you call APS?
No - only for the disabled or elderly ages 60+
These are the circumstances you would use "meeting" for:
what are 1:1s, team meetings, skip level meetings?
Region 2 sends their PO tasks to this rockstar
Who is Ruqayyah Muhammad?