HIPAA
Why is HIPAA important
To protect the security of the account and make sure we are speaking with the right person
What does HEDIS stand for?
Healthcare Effectiveness Data and Information Set
When a member requests a new ID card do you select existing case or create a new case?
Create a new case
If a member calls and says they need to get a reward for completing a screening what do we do?
A Wellness Attestation
To do a demographic change, do you create an account or select an existing account?
Create an account
How many pieces of information must we verify in order to meet HIPAA requirements for HEDIS?
3
How many HEDIS measures are there?
90+
How many replacement cards can a member request in a 12 month period?
There is no limit
to do a wellness attestation do we select an existing case or create a new case?
Create new
If a member wants to change their phone number on file, what do we do?
Update Contact Information
HIPAA insures protection of PHI. What does PHI stand for?
Which is not a HEDIS domain:
Access/Availability of Care
Patient Safety
Utilization
Effectiveness of Care
Patient Safety
One of our states has a different time-line for receiving ID cards. What state is it and how many business days?
Iowa is 5 business days
What would you type in to create a case for Wellness Attestation?
Care Connections
If a member moves, but has the same mailing address for example a P.O. Box, what do we do?
Have them contact their local Medicad office to update their physical address
What has to be filled out in order to get to the HIPAA card?
Language (if other than English)
Interpreter number (if using GLOBO)
Name of person we are speaking with
Call back number
Is the person the member or parent/guardian of member
Which is not a HEDIS measure
Asthma medication
Surgery outcomes
Cancer screening
Surgery outcomes
Is there a way for a member to print a copy of their ID card?
Yes, on the member portal at mymolina.com
Once you have the wellness attestation case opened, where do you click?
Wellness Attestation tab
A member on the phone says she just got married and wants to update her last name. What do you do?
Have her contact her local Medicaid office.
If adding verbal consent, how long is verbal consent effective?
14 days
True or False: HEDIS measures include preventive care
True
If a member does not have a physical card, is there a virtual option for them to show at their Dr office?
Yes on the mymolina app
After completing the wellness attestation, what is the next step?
Associate to Campaign
What are the 2 things we can update in demographic change?
Mailing address and emergency contact.