Name that Team
This condition determines whether a referral is appropriate to the PIP Team.
What is pregnancy?
This level of care represents our highest severity.
What is CCM Complex case management LOC.
This type of question is used to encourage conversational dialogue with the member.
What are open ended questions?
This number is used after logging into CSC to determine 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 performs initial outreach to members.
What is member engagement?
This minimum standard frequency of calls - every 12 weeks/quarterly represents this level of care.
What is CC Coordination of Care low 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?
What is the stage of change of ACTION?
This number is used to check member claims.
What is 125?
This is when a City of Suffolk member's episode should be closed if they were successfully outreached for 1st quarter incentive and case management services but were UTCx3 during 2nd quarter outreach.
What is the start of the 3rd quarter?
This team may receive a referral after an inpatient admission for depression.
What is behavioral health team?
This LOC represents a member who's assessment demonstrates well controlled Diabetes with A1C 5.9 and COPD controlled with prescribed treatment plan.
What is CC Coordination of Care low LOC?
The member becomes defensive, interrupting often, and sounds annoyed and distracted. This motivational interviewing approach can be utilized by the case manager.
What is Rolling with Resistance?
This abbreviation is used to check authorizations on the 124 screen.
What is AU?
The member states "I take all my meds as I should, I go to all my doctors appointments and my conditions are under control. Thanks for calling, but I don't need anything. You can add me to a list to not get any more calls from the health plan". This is what the CM should chart.
What is a refusal and a Do Not Contact keyword.
This team makes outreach calls to members interested in particpiating in Sentara's Weight Management Program.
Who is disease management?
This LOC represents a member who's assessment demonstrates complex cardiac history including NSTEMI s/p multiple stents and stable CHF, well controlled diabetes with A1C 5.9, and recurring ED visits (3+) over the past 2 months for UTI.
What is CCM complex case management LOC?
The member has a 20 year PPD smoking history, and states they have "too much family stress and it's not a good time to quit smoking." This member is in what stage of change?
What is pre-contemplation?
The CSC number 124, then BA, then AS shows this member information.
What is the deductible & MOOP? OR what is the deductible? OR Lifetime max.
While completing the HRS, this is where the team member would document member refusal.
What is within the HRS and the call tracker note.
This team manages members who have experienced a major health event or diagnosis that requires the extensive use of healthcare resources, including multiple providers.
Who is the complex team?
Member with CM severity, UTCx3, this assessment should be documented prior to placing episode in hold status.
What is OPT Level of Care Change assessment?
This is the root of a member's "Why" behind achieving their personally defined goals.
What is intrinsic motivation.
This CSC number sequence gives you the option to find provider information
What is 411 then 3?
The member states "I already take all my meds as I should and I go to all my doctors appointments, and I don't need anything." This is what the case manager should do next.
What is assess additional case management needs and member's willingness to participate in case management.