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Know this
Why,What, and How ?
100
Every member of the family receiving assistance can be found under this
What is Family Link ID
100
If you send a letter to a lost contact member, you should wait -- ---- before closing the member from case management
What is "15 days"
100
This determines how often you outreach to a member
What is the "Episode Class"
100
I must have all three of those to make up a care plan
What are Problems, Goals, and Intervention
100
Case Management is one collaborative process in which this should always take part in all decision making
What is "the member or his/her representative"
200
You should do this before providing any service to a member
What is "check eligibility"
200
Until you complete all required assessments, enter a note, and add a call, you cannot classified a member as being
What is "Engaged"
200
Reasonable attempt must be made to contact a new member and that is
What is "having two documented phone calls on two separate days at different time of the day"
200
All goals must be prioritized and you must have at least one of those goals
What is "High Priority Goal"
200
The primary goal of case management is to
What is "promote quality of life, reduce health care fragmentation, and reduce health care costs."
300
This tab allows you to document that member agrees to receive phone calls
What is "Preferences"
300
A member agreeing for you to discuss medical condition with a caregiver should be treated and documented as
What is "verbal consent"
300
You can attach a document to an episode while here
What is the "Workflow"
300
When working the plan of care you must document in each of those areas after each follow up outreach
What are call log, note, and an interaction
300
This is the primary roles of case managers
What is "Assess, Plan, Facilitate, and Advocate"
400
This is one of the places you can log a call to a member
What is a "Call Tracking"
400
When making outreach calls to members before you begin discussing any medical related issue, you should first
What is "Confirm member identificaty"
400
You are logging your first successful call for a new member the selected broad topics should be
What is "Assessment Outreach"
400
Prior to closing a member from case management due to lost of eligibility this must be changed to an "F" and you monitor eligibility status for 30 days
What is "Episode Class"
400
This is the FOCUS of case management
What is "Achieve health and maintain wellness"
500
One of Amerihealth Caritas policies is that all documentation involving substance abuse should be entered as
What is "Sensitive Notes"?
500
This piece of information can help verify member's compliance with medication
What are "Pharmacy claims"
500
Those two CM workflow tabs are not used
What are "Screening Assessments" and "Educational Materials"
500
While on the workflow, the interaction screen can be accessed here or here
What is Activities or the plan of care
500
CMSA defines case management as a collaborative process of assessment, planning, facilitating, and advocating for options and services to meet an individual's needs through communications and available resources to promote
What is "What is "quality cost-effective outcomes"