Medicare
What part of Medicare pays for Hospital stay?
Part A
When was the ACA law passed?
March 2010
This role is your all-knowing and unerring resource for everything you need.
Clinical educator
BCBS main documentation system
GuidingCare
Where do we go to get our ID badge?
Security
How long must you work to earn premium free Part A?
40 quarters or 10 years
Name one thing the ACA is best known for.
•Coverage for pre-existing conditions
•Kids covered on the their parents health plan until age 26
•Individual mandate
•Employer mandate
This role is the nexus point for the team. They are responsible for building authorization shells, assisting their team, and embracing their flexible job duties.
Medical Management Coordinator MMC
System where all faxed, mailed, called in requests end up.
Perceptive
Who is the vendor BCBS uses to manage diabetic members?
Livongo
If you have Medicare Part A and Part B, what is also recommended for you to have also?
Medigap
How many counties does the BCBS ACA plan cover?
32 counties
They work with members by conducting an assessment, develop a care plan, coordinating care, and being an advocate.
Case Manager
Claims system
FACETS
Who is the Vendor we use to help care for members with mental health diagnosis?
New Directions
What condition must you have in order to get Medicare if you are under 65?
ESRD or ALS
Blue Select and Blue Select Plus include ________ as options for primary care.
Spira Care
This role perform medical reviews for request for services.
Clinical review RN
Application where the member and case manager can keep in touch.
WellFrame
Who is the vendor we use to review imaging?
Evicore
What is it called if a patient has both Medicare and Medicaid?
DSNP or Duo Special Needs Population
Rx Select pharmacy network does not include ________.
CVS
This roles deals with member who disagree with the company.
Appeals RN
What is our Virtual desktop called?
VDI
What program do we use for meetings, chatting, and sharing files?
MS Teams