Name that Team
This question determines whether a potential referral is appropriate to the PIP Team.
What is "are you pregnant?"
This level of care is representative of a member with a new A1C of 10.0
What is CCM Complex case management.
This kind of question is used to encourage open dialogue with a member.
What are open ended questions?
What is the screen you first log into to check member eligibility and LOB?
What is 124?
This is the length of time a member should be placed on hold after refusing case management?
What is 30 days?
This team often performs initial outreach for potential members.
What is member engagement?
This minimum standard frequency of calls of every 12 weeks or twice per year represents this level of care.
What is CC Coordination of Care low LOC?
The member has a 20-year pack per day smoking history and claims "My life is too stressful right now and it's not a good time to quit smoking." This member is in what stage of change?'
What is pre-contemplation?
This code is used to check member claims.
What is 125?
This is the length of time a member should be placed on hold if they are outreached for incentive and case management services but were UTC x3
What is 90 days?
This team may receive a referral for a PHQ assessment over 6.
What is behavioral health team?
This assessment should be performed when placing a member on hold.
What is LOC assessment?
The member becomes defensive, interrupting often, and sounds annoyed and distracted. This motivational interviewing technique demonstrates the right approach for the case manager.
What is Rolling with Resistance?
This code is used to check authorizations under the 124 code.
What is AU?
The member states, "I go to all my doctors appointments, take all my meds", and don't need anything." This is what the CM should chart.
What is a refusal?
This team makes hundreds of potential outreach calls and completes HRS and encourages members to take part in case management.
What is member engagement?
This LOC represents a member who has complex cardiac history including NSTEMI with multiple stents and stable CHF, diabetes with an A1C below 6.0, but who has recurring 3 ED visits over the past 2 months for UTI.
What is CCM complex case management LOC?
This weight loss incentive member has started going to the gym 4 days a week for one hour each visit, logging food and nutrition, and decreased nighttime snacking and has lost 5 pounds with these interventions over the past month. This member is in what stage of change?
This CSC code 124 then BA then AS shows this member's information.
What is the deductible & MOOP?
This is where the CM should document the reason for refusal by the member.
What is the call note?- and plan of care if applicable.
This team manages members with several acute comorbidity often requiring intensive support and NCM interventions.
What is the complext team?
This LOC represents a member with Diabetes that is well controlled with an A1C below 6, CHF, and COPD that are all well controlled.
What is CC Coordination of Care low LOC?
This type of question is used to help members define their own goals and motivation to reach goals
What is finding your WHY?
This code gives you the option to find provider information.
What is 411 then 3?
This is where it should be documented in JIVA to indicate that the member wishes to be placed on the DO NOT CALL list.
What is the "Keywords" section of JIVA?