Customer Service Overview
When was the California Medi-Cal Dental program created?
By the legislature in 1966.
What are the 2 programs that Medi-Cal dental provides?
Managed care plan and fee for service.
are you allowed to have side conversations while on camera during training?
No.
Members may be elgible under what?
Multiple aid codes in a single month.
What does HIPAA stand for ?
Health Insurance Portability and Accountability Act
Who handles erroneous documents for the CSC?
Which county has a choice between MCP and Fee for Service?
Los Angeles County or LA county.
Who is Batman? Hint; they're in the class.
Leilani.
Members with questions about their share of cost should contact who:
Their county social services office.
Why is HIPAA compliance important?
HIPAA protects patient privacy by legally enforcing rigorous technical, administrative and physical security controls on healthcare businesses who electronically transmit sensitive health information. Anything close to this is acceptable :)
What is the CSC availability? Hint; Multiple answers.
open year round, open monday through friday 8am to 5pm excluding holidays, the IVR automated system is available 24 hours a day seven days a week.
Which provider provides tooth extractions, especially wisdom teeth, major jaw surgeries, treats infections in the head and neck region and treats injuries and deformities that affects the mouth
Oral Surgeon.
Are you allowed to show just fore, five, 6 10 heads on camera? lol
no, we need to see your whole face.
In certain cases identification verification is NOT required for example when a member is..... Hint; multiple answers apply.
Receive emergency services, 17 years of age or younger, a resident of a long term care facility.
What are the penalties for violating HIPAA laws?
a penalty of up to $50000 and up to 1 year in prison
What are some CSC call metrics? Hint; multiple answers.
wait time under 60 seconds for incoming calls, abandoned calls band busy rates under 5 percent, one day turn around on voice mails, 95% accuracy score on quality monitored calls.
Which county of members MUST sign up for the MCP?
Sacramento
up to 5 minutes early. But have to clock in on Onepoint at 8am
For adults age 21 and over, Medi-Cal will pay up to $1800 a year for covered dental services. This "soft cap" is exempt for some groups. What are they?
Women who are pregnant, medically necessary procedures and members under 21
what entities or business are required to follow HIPAA guidelines?
Health plans and most health care providers
What are 3 examples representatives can help members with in regards to Claims? Hint; multiple answers.
TAR status, complaints, conlans.
Which age group has the most covered services?
teens
Who do yall love the most? Scotlyn, Angie, Lei or Dan Man?
any one of us lol cuz we love yall.
A share of cost is an amount a member must pay out of pocket each month before Medi-cal dental will pay for covered services. Share of cost is..... Hint; multiple answers.
varied from month to month
Assigned to an individual or family plan
based on income and family size
determined by the county office
What are the 3 main rules of HIPAA? Hint; you can use google.
The privacy Rule, the Security Rule and the Breach Notification Rule