questions set 1
Member changes PCP and seen old PCP the day of the call what would be the effective date of the PCP change?
What is the day after the call.
Routine eye exams, office visits by PCP, Mammograms, ER visit
What is services that do not require a referral
Case mangers to answer questions, transportation to doctors visits and breast pumps.
What is the GEMS program
EMEVS
What is the source of truth
there is no PR on file and the member is 12 can we speak to anyone.
What is only if they identify themselves as the parent and the give you the child name, ID# and DOB.
Medicaid Expansion plan
What is ABP
Gallbladder surgery, DME over $250,
what is authorization
Ensures claims are paid correctly, ensures that the amount paid does not exceed 100% of the allowed amount, and help avoid duplicate payments
What is COB
Medline
what is the vendor for incontinence supplies
Member self-referred to a specialist and submits the bill to Horizon NJ Health for reimbursement
what is Horizon will not pay the bill
aged, blind, and disabled
What the ABD plan
payor of last resort
What is Horizon NJ Health
866-874-3972 EXT 210780
what is the language line
Pharmacy hours of operation
What is 24/7 365 days a year
Every 2 years or sooner if medically necessary
what is eyeglasses
NJ Family Care A, B, C, and D
What is plan/plans that cover children based on household income?
Chantix, Nicorette
What is things that the provider can prescribe to help the member to stop smoking
7INC
What is member is incarcerated
Sent using material request in facets, download from the Horizon NJ Health website and fax it in, or through the member portal
What is personal rep form.
800-372-8320
What is the fraud hotline
MLTSS
Managed Long Term Services and Supports
Methadone
What is Horizon NJ Health covers the medication and the administration of.
Horizon ID#, effective date, co-pay if required,
What is the Member ID card
Internal medicine , family practice, pediatrics
What is providers who can be a PCP
30 days
What is the member will lose Medicaid eligibility