Member Handbook
The Member Services' phone number is...
866-329-4701
This letter should be mailed out for the first visit and within 60 days of enrollment.
Welcome Letter
Abuse, neglect, exploitation
This desktop includes POA information, code status, and education on documents/resources.
Advance Directive
MLTSS stands for
Managed Long Term Services and Supports
This benefit assists member with getting to their medical appointments
MotivCare
This assessment is completed for social determinants of health specifically education.
HCE Assessment
You would report suspected abuse, neglect, or financial exploitation of members living in nursing facilities (NF) to this entity.
IDPH
This desktop talks about post-discharge outreach regarding a score
RAP 2.0
You can find eligibility, claims, and share of cost in this resource
QNXT
Aetna Better Health covers this benefit, a removable replacement for missing teeth and surrounding tissues.
complete dentures
This is evidence of a schedule for follow-up and communication with members
Task
The following template is for which type of CI outreach:
1.Incident Date:
2.Date and time of resolution
3.How was the reported Critical Incident resolved? CC follow up ensuring member’s safety and wellness, follow up with IA for the final investigation outcome and recommendations.
4.Was the event determined to be substantiated? Follow up with IA after receiving ROS within 5 calendar days.
5.Are there any supporting documents related to the resolution linked
to the member’s file? If Yes, what documents are linked.
5.Does the member currently feel safe and are his/her needs being met? * (Ensure member’s safety, health and welfare, speak with member or POA, if unable to speak to member or POA please provide detail).
6.Was the member’s care plan updated?
7.ANE Education provided:
Critical incident resolution
This desktop talks about goals, letters, review dates, and preferences
Care Plan Development and Planning
This website has member contact information, recent hospitalizations, and ED visits
Collective Medical
According to the handbook, Cosmetic Surgery is listed under this type of service.
a non-covered service
According to audit question #9, a comprehensive assessment should be completed within how many days of a significant change
5 days
Any alleged act or behavior that occurs during the provision of, or as a result of services provided that may be detrimental to the quality or safety of patient care, is not compliant with clinical evidence-based practice standards or that signals a potential sentinel event.
PQOC
This desktop talks about how to outreach members who do not have known whereabouts
Unable to Reach Process
This team helps members who have been identified for either Colbert or Williams class
Transition Team
Aetna Better Health offers a 24-hour line where members can talk to a behavioral health professional
Mobile Crisis Response Services
This question is asking if the annual assessments have been completed for a member
question #7
what type of CI is this:The misuse or withholding of a member's assets and resources (belongings and money). It includes, but is not limited to, misappropriation of assets or resources of the alleged victim by undue influence, by breach of fiduciary relationship, by fraud, deception, extortion, or in any manner contrary to law.
Exploitation
This desktop talks about visit events, assessments, and frequency of outreach based on program type.
Assessing and Evaluating LTSS Program Members
Rising to the challenge, Joining Forces, Putting People First, Creating Simplicity, and inspiring trust
Heart at Work Behaviors