Show:
BONUS
Medicare
Medicaid
Grievances
CAHPS
100
Traditional Medicare...
What is Fee For Service (FFS)
100
was implemented in 1966 and currently provides health insurance coverage for millions of Americans
What is Medicare
100
Policyholders can only purchase this type of coverage
What is single
100
any complaint or dispute other than an organization determination expressing dissatisfaction with the manner in which a Medicare health plan or delegated entity provides health care services, regardless of whether any remedial action can be taken.
What is a grievance
100
refers to a comprehensive and evolving family of surveys that ask consumers and patients to evaluate the interpersonal aspects of health care.
What is CAHPS
200
Medicare claim number..
What is HICN
200
is responsible for administering Medicare, Medicaid, HIPAA and other health-related programs.
What is CMS
200
Members can reduce or eliminate the pre-existing condition waiting period by showing proof of
What is continuous coverage
200
If a grievance is received from someone other than a member, this form will be required
What is an Appointment of Representative (AOR)
200
In addition to the publicly reported composite measures listed above, the survey questionnaires include several publicly reported “member overall” ratings based on this scale
What is 0-10
300
PBM
What is pharmacy benefits manager
300
A policyholder may request this at any time for any reason.
What is termination of coverage
300
Date reported, date of occurrence, caller, grievance, grievance category, less than 60 days, expedited, response, all issues resolved, request in writing, provider information
What is three things that should be captured when documenting a grievance
300
The Medicare Advantage and Prescription Drug Plan CAHPS Survey is administered using only this type of collection protocol
What is a mixed mode data
400
helps sort/ search through a large list of information in UCSW
What is query
400
OEPI stands for
What is Open Enrollment Period for Institutionalized Individuals
400
If the grievance can not be resolved on first contact (24 hours) then the representative will document steps taken in the investigation and route the SR to the
What is Medicare Grievance Team
400
CMS collects information about Medicare beneficiaries’ experiences with, and ratings of
What is Medicare Advantage (MA-only) plans Medicare Advantage Prescription Drug (MA-PD) plans And stand-alone Medicare Prescription Drug Plans (PDP)
500
requires authorization but hasn't been rendered
What is pre- service appeals
500
A benefit package groups can offer their retired employees age 65 and over
What is carve out coverage
500
If a policyholder is enrolled in a Horizon Medigap plan and subsequently enrolls in a Horizon group health plan, we cannot terminate the policyholder’s Medigap plan unless the policyholder requests it
What is Subsequent enrollment under Horizon group health plan
500
related to the member’s health.
What is quality of care grievances
500
allows objective and meaningful comparisons among MA and PDP contracts on domains that are important to consumers.
what is The MA & PDP CAHPS Survey