Departments/Vendors
KMS
Provider Directory
Preventive Services
Networks
100
The department that takes both member and provider calls.
What is the customer service team?
100
The topic that houses information on periodic health exams.
What is the Preventive Services or Healthcare Reform topic?
100

The name of the only hospital located within 5 miles of zip code 97068 for MBR ID 112960565-00.

What is Providence Willamette Falls Medical Center?
100

A group that is allowed to have a cost-share for preventives services and an option to provide benefits that favor highly paid employees.

Extra hint: It states GR at the bottom of the benefit summary.

What is a grandfathered plan?
100
The network used for choice members.
What is the Providence Choice Network?
200
The vendor that sends out member ID cards and materials.
What is Clarity?
200
The topic that houses directions on how to order an ID card.
What is the "ID Cards and Member Materials" topic?
200
The number of results when searching for a medical home/neighborhood for MBR ID 113047871-00 within 5 miles of zip code 97045.
What is 9?
200
The numbered limit of how many annual GYN's a member can get in a calendar/plan year.
What is 1?
200
The network used for Connect members.
What is the neighborhood network?
300
The department made up of clinical staff that review prior authorization requests and claims for medical necessity.
What is Healthcare Services (HCS)?
300
The topic that has information on breast pumps.
What is the DME, Pregnancy or Womens Health topic?
300
The names of the two male, Spanish speaking orthopedic surgeons listed within 5 miles of zip code 97216 for MBR ID 100185415-00
Who are Douglas Bald and Gavin Button?
300
This happens if a member sees a non-participating provider for a routine physical.
It falls to the member's OON benefits and the member has a higher cost share.
300
The network used in Oregon and SW Washington for all non Choice and Connect members.
What is the EPO/Signature network?
400

The vendor used for high tech imaging prior authorizations.

What is AIM (American Imaging Management)?
400
The topic that houses information on circumcision benefits.
What is the Newborns, Surgery, Pregnancy or Mens Health topic?
400
The network that Dr. Ann Bridges, OBGYN, is a part of at 904 7th Ave for MBR ID 112865011-00.
What is the FCHN network?
400
The place in which a choice or connect member must be seen to receive in-network benefits for their periodic health exam.
What is the member's medical home/neighborhood?
400
The network used for a member with in-network benefits in Seattle, WA.
What is the FCHN network?
500

The department made up of 3 subsections that is responsible for making sure PHP is not paying out more than we need to on claims.

BONUS: Can you list the three sub departments?

What is OFT (Operations Financial Transactions)?

BONUS ANSWER: What is COP, TPL and Refunds

500
The topic that houses information on infertility benefits.
What is the Pregnancy topic?
500
The name of the only UC facility located within 5 miles of zip code 97006 for a prospective individual choice member.
What is Providence Medical Group - Tanasbourne Immediate Care?
500

The labs that are considered preventive for adults and therefore CIF for member's on a non-grandfathered plan who have adopted PPACA.

What are: Cholesterol Screening, Diabetes Screening, Hep C Virus Screening (for adults born between 1945-1965), HIV Screening and Counseling, and Syphilis Screening.
500
The network used for a member with in-network benefits traveling to Boise, Idaho? (Southern Idaho)

What is Brightpath OR PHCS/Multiplan Network?

***Network layering***

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