Workflow
What are the HIPPA identifiers that are to be used during every outreach, and how many are mandatory?
Name, DOB, address, member ID
Must have 3 identifiers
COS door to door requests should be sent in Jiva for which enrollees?
High PICS, inpatient referrals, top 1%, or based on clinical judgment
What platform do you access to send HIPAA compliant text messages to enrollees?
Upfront
What is the current Population Health policy for unplanned PTO or alternate work location request?
Email direct supervisor and manager
At the Maine Ave location, how many conferences rooms are available for use?
3- Executive, Large, Small
What is the timeframe from identification date to first outreach?
1. Within 1-3 business days of receiving the referral for PICs top 1%, inpatient admits, priority populations, and urgent referrals
2. Within 5 business days of receiving the referral for routine referrals.
Who is the manager of Quality?
Legina Driscoll (Jigi)
After verifying an enrollee has successfully or unsuccessfully accessed a community resource, what platform is used to documented a closed loop referral?
FindHelp
What is the same day requirement prior to a scheduled case management face to face engagement?
On the day of the visit call the enrollee to confirm appointment
*Per SOP ICTM F2F
Name two monthly event for enrollees made available through ACDC?
What is the one mandatory goal in a Care Coordination plan of care?
General Care Coordination Pathway
Who is the ACDC Medical Director?
Dr. David Granger
What platform is used by leadership team for call monitoring and real time monitoring?
Genesys
What is the next step for a Care Connector/ Peer Recovery Specialist who receives a death notification from a family member or caregiver (multiple steps)?
Associate offers bereavement services and community resources as appropriate.
Associate adds “Sensitive Note” about the enrollee’s death (date) in JIVA.
Associate sends email (date of death, name, Member ID) to the IHCM/Population Health/COS Supervisor and Manager.
Supervisor or Manager completes the Quality Indicator Assessment.
How do you notify enrollment team if an enrollee has moved out of state?
Enrollement Update Request Form- Google Forms
What is the timeframe before an episode is considered overdue, both Care Coordination and Complex?
What ACFC team will support enrollees with finding in network providers, booking appointments, and connecting to community resources?
Rapid response outreach team (RROT)
Which platform is utilized to review pharmacy claims?
Darwin
What is the name of the guiding ACFC document that ensures secure use of PII and PHI?
Acceptable Use Policy
How are documents translated into large print, or audio recordings for our visually impaired enrollees?
Email ACSI at production@acsitranslations.com
What assessment needs to be completed for every Complex episode within 60 days of identification date?
Disease specific assessment
Who would you contact with any facilities related concerns for the office at Maine?
Hermilo Estrada (Milo)
Which platform is used to manage and review retirement benefits, such as 401k?
Empower
As outlined in the Acceptable Use of PHI policy, we must obtain a written authorization signed by the member prior to disclosing PHI. What platform is used to obtain written consent?
Consent Management
How can individuals demonstrate compliance with the new HR1 Medicaid Work Requirements?
Current Medicaid Enrollees: The District will require that currently enrolled individuals subject to work requirements meet criteria for any one month during the individual’s most recent eligibility determination and redetermination of eligibility
Work at least 80 hours
Complete at least 80 hours of community service
Participate in a work program for at least 80 hours
Be enrolled in an educational program (school) at least half-time
Engage in any combination of the above for a total of at least 80 hours
Have a monthly income that is not less than the applicable minimum wage requirement of section 6 of the Fair Labor Standards Act of 1938, multiplied by 80 hours.
For a household of one, someone earning near the District Living Wage could work approximately 33 hours a month and meet this income requirement.
This amount is equal to roughly 44% of the FPL for a household of one or $580.