Week 1
What does SOC stand for?
Share of Cost
providers submit this form to bill for payment
claim/tar
The toll free number for members to call is?
1-800-322-6384
Authorized Representatives are the exact same as Personal Representatives, true or false?
FALSE
What screen do you go to to do your HIPPA check on?
FAME Inquiry Details Screen
Regarding the Month of Eligibility, how would you write December 2023
2312
This document is SENT to providers if more information is needed for final adjudication
RTD - Resubmission Turnaround Document
True
If a member does not like the findings of their complaint they should file for a...
State Hearing
What does FAME stand for?
Fiscal Intermediary- Access to Medi-Cal Eligibility
Which office determines the members eligibility?
County Social Services Office
What does treatment does code D0274 indicate?
Bitewings- four radiographic images
What does PAVE stand for?
Provider Application and Validation for Enrollment System
What is a Position Statement
letter stating member did not win the state hearing
What are the 4 pieces of information required in the FAME Inquiry Details page?
First Name, Last Name, Date of birth, and BIC or SSN
what 2 pieces of information can you obtain from the Aid Codes
Benefits and Share of Cost
What two things can a Claim Inquiry Form be used for?
Re-evaluation (for payment) of billed services that were denied or modified on an EOB,
or
As a Claim/Tar tracer to follow up on documents after 30 days
All calls not resolved immediately are listed in the
Aged Enrollment Correspondence Exception Report.
when a member receives a Pink Letter who can they take it to?
Any Medi-Cal Dental provider accepting new patients
What is OBRA
Omnibus Budget Reconciliation Act
What are the 4 alternative english language formats can a member ask for?
what form is used in response to a Claim/TAR Tracer?
Claim Inquiry Response (CIR)
What does CRM stand for?
Customer Relationship Management
what does HLD stand for?
HANDICAPPING LABIO-LINGUAL DEVIATION
Where is FAME located?
CD-MMIS