Hipaa
What is considered general plan information you are able to give un-authenticated callers?
What is anything that is public information available online.
If a member is QMB do they have to pay co-pays?
What is No- Medicaid pays their cost share.
What is our fitness membership called?
What do we use to look up medications?
What is the Formulary.
What should we submit when a member needs to see an out of network doctor?
What is an MIOD.
If someone calls for a member and is not on the account, what must you have in order to speak with them?
Where can you find a members Medicaid ID?
What is DMEV'S
Name 3 activities member can complete in order to get a visa gift card through Renew Rewards?
Flu shot, HRA and AWV
What is 7 days
When should a grievance be submitted?
Anytime a member expresses dissatisfaction.
What can you NOT update with an AR?
What is address and PCP
How many levels of Medicaid are there that a member can have?
What is 8
What does comprehensive dental cover?
How many tiers are there?
What is 5.
What is the definition of Quality of Care?
Quality of care complaints are ones about services received by a member from a medical provider, medical facility, or pharmacy, which were inadequate or substandard in quality. These complaints include an indication that the member's care, or ability to receive care, has been or could be affected. In addition, it is possible that the member expected a service to be provided and that service was not properly delivered. The delay in receiving these services would affect the member's care, and are considered inadequate care.
What should you do if a member will not verify hipaa?
What is a Medicaid MCO?
What is a Managed Care Organization.
What are 3 places you can find a members benefit information?
What is Maestro, Ibaag and EOC.
What does LIS stand for?
What is a verbal grievance.
What intent do you use to add someone to the members account? And what do you need before you can add?
What is Manage Auxiliary and verbal permission
For DSNP plans, who sends the bill to Medicaid?
What is the provider/biller.
What are 4 ways a member can use their OTC benefits?
What is online, instore, on the app or over the phone.
Why would a member's diabetic test strips deny at the pharmacy?
What is they are covered under part B.
What is no. We need to submit them per CMS.