Medical Homes
The medical home's Provider ID in Facets starts with these 4 letters.
What is M - E - D - H?
The numbered limit of how many annual GYN's a member can get in a calendar/plan year.
What is 1?
Whether or not Choice members have access to national networks (benefits outside of Oregon).
What is no?
The amount that MBR ID 100207113-01 has met towards her 2018 OOPM at the end of the year.
What is $1230.13 of $2000?
ASO stands for this.
What is Administrated Services Only?
The 4 ways that a medical home can be selected for a member.
What are by mail, MyProvidence, email, calling into CS
The benefit quote for a routine physical, in-network, for MBR ID 100207423-03.
What is CIF, deductible waived?
Where information on Tobacco Cessation programs are housed in KMS.
Where is Health and Wellness?
The amount that MBR ID 113129171-01 has met towards their individual cost share.
What is $7900 of $7900?
This is what happenes when more than one perosn is enrolled on an HSA plan.
What is family accumulators apply? (HSA plan - more than one person enrolled on the plan)
Using MBR ID 100858835-00 the provider directory or Facets, tell me whether or not Dr. Scott Alexander, in Klamath Falls (zip 97601) practices out of a medical home or not.
What is yes?
BONUS Bragging Points: What's the name of the medical home?
Whether or not a member on a calendar year plan has to wait a full 365 days before going in for another annual gyn exam for it to be covered-in-full.
What is no? Calendar year - member can go in anytime during that next calendar year.
Where you can direct members for more information on the Active & Fit Direct Program.
Where is http://providencehealthplan.com/discounts or their MyProvidence account?
The number of OP rehab visits that MBR ID 100576040-03 had remaining for 2018.
What is 18?
True or false: Commercial plans are self-funded.
What is false? They are fully-funded.
The number of times a member can update their medical home.
What is unlimited?
The place in which a choice must be seen to receive in-network benefits for their periodic health exam.
What is the member's medical home/neighborhood?
Whether or not a member would be responsible for any cost share amount for the ER room if their cost share limit has been met for that year?
What is no?
Whether or not this member used their Cholesterol screening in 2019. - MBR ID 100720354-00
What is yes?
The types of providers that can perform a member's annual gynecological exam.
What are PCP, GYN, OB/GYN, PA, ARNP, CNM or naturopathic providers (for non-grandfathered members)?
Using MBR ID 113244162-00, tell me whether or not Dr. Robert Byerly can be a covering provider for Dr. Mustaquim Chowdhury.
What is yes?
Provider TIN and specialties match. Both providers work out of Hillsboro Internal Medicine Clinic.
The labs that are considered preventive for adults and therefore CIF for members on plans that have taken on the reform.
What are: Cholesterol Screening, Diabetes Screening, Hep C Virus Screening (for adults born between 1945-1965), HIV Screening and Counseling, and Syphilis Screening.
Denise's favorite kind of food.
What are donuts?
Whether or not MBR ID 100663335-01 has deductible 4th quarter carryover.
What is yes?
Whether or not Dr. James Beckerman can be a covering provider for Dr. Roxana Abbott or not.
*Use MBR ID 100560078-02 for Facets lookup.
What is no? Provider specialties do not match.
Dr. Beckerman is a cardiologist. Dr. Abbott is family practice.