Vendors
On the HealthNet website, where do you go to search a dentist, vision provider, alternative medicine provider?
What is Ancillary Services?
Dave has Medicare Part A and Part B and also has partial Medi-cal, which HN MAPD plan would be best for Dave?
What is Amber 1
What does HIPAA stand for?
Health Insurance Portability and Accountability Act.
Member calls in and notifies the agent he has Diabetes Mellitus, what type of plan would you recommend for this member?
What is Chronic Special Needs plan?
These are 5 department roles.
Manager, Supervisor, Lead, Medicare Support Team
These are our 2 vision vendors.
What is Envolve and Eye med
Greg is a retired veteran who just moved to California, he has credible RX coverage through the VA and he is looking for an MA only plan. Which plan would be best for Greg?
What is HealthNet Green?
How many HIPAA identifiers must the member provide before we are able to release any PHI/PII?
What is Three
This is the document the member can navigate to on the plan website to find out if their Prescription is covered.
What is the Formulary (List of drugs)?
These are 3 key departments.
What are Appeals, Grievances, Medical Management, Pharmacy Service Center, Claims, Enrollment, Provider Data Management
What is Envolve, Delta Dental, Health Net Dental, Liberty Dental Plan.
How many states does CENTENE offer plans in?
What is 32 States?
What is the definition of PHI and PII?
What is Protected Health Information and Patient and personally identifiable information.
The member checks their plan documents and sees that they have comprehensive coverage. Oral surgery is considered a comprehensive dental benefit. True or False?
What is TRUE
These are two ways claims can be submitted.
What is Electronically and in paper format?
Kelly often goes through depression, which vendor would you use to find her some help?
What is Managed Health Network (MHN)
These 2 states offer ONLY PPO plans?
What is Indiana and Oregon
These are examples of PHI/PII.
Member's Health Net ID number, Plan name (current or previous), Plan effective dates, Address, Medicare Part A/B effective dates, PCP/Provider Assignment, Social Security number (obvs), HICN/MBI.
I am a plan that shows up in scavenger hunts and this year's training but I was discontinued last year and not available in 2020.
What is 2019 Allwell Complement?
What is Model of Care?
What is management program for members with special needs?
David has both Medicare and Medicaid and resides in Lane county Oregon, he wants to know which vendor covers his fitness benefits.
What is international fitness?
David has both Medicare and Medicaid and resides in Lane county Oregon, he wants to know which vendor covers his fitness benefits.
What is International Fitness?
All (Blank) Must provide 3 HIPAA identifiers prior to release of any PHI/PII
What is All callers?
I am the only Allwell C-SNP plan.
What is Allwell CHF/Diabetes?
I am the Job Role that manages the following requests:
Prior Authorization requests, Urgent Authorization requests that are past turnaround time, Authorization extensions, Continuity of Care Requests, Care management.
What is Medical Management Job Role?