Medical Terminology / Abbreviations
What does DME stand for?
Durable Medical Equipment
What is the name of the program you will be part of?
CalAIM ECM Program
Enhance Care Management & Community Supports
What form do we use to confirm Population of Focus eligibility?
Population of Focus Screening Checklist
How can a member go see a specific specialist?
Member must request a referral with primary care provider during upcoming appointment. Member must express their reason for request and LCM must follow up until referral has been approved.
What is your current role?
Lead Care Manager
What is a PCP?
A primary care provider/physician who sees people with medical problems. This person is most often a doctor. However, a PCP may be a physician assistant or a nurse practitioner.
What health plans do we work for?
1. LA Care
2. Health Net
3. Blue Shield Promise
4. Anthem
5. Aetna
What second form do we use to confirm duplicative programs eligibility?
Exclusionary Screening Checklist
What kind of specialist needed for this:
Pain Management Specialist
Where do I check who my ECM Leader is?
BambooHR
What does EMR stand for?
Electronic Medical Record
What is the difference between a dual-eligible member and a medical-eligible member?
Dual has both Medicare and Medical
Medical eligible has ONLY Medical
2 months from now your member mentions getting enrolled into a new program. How do I check if my member is still eligibility for ECM?
LCM must check eligibility by:
1. Complete Population of Focus Screening Checklist
2. Complete Exclusionary Screening Checklist
What is an ophthalmologist?
A specialist who checks the eyes
How do I reach out Titanium staff?
1. Microsoft Teams
2. Outlook Mail
What is the name of the first appointment we have with our member?
Initial Care Management Plan (iCMP)
What programs should member be part of to be eligible for ECM Program?
1. Medical
2. Medicare
If the member is eligible to enroll, what forms do we need to complete?
1. Population of Focus Screening Checklist
2. Exclusionary Screening Checklist
3. ECM Referral form
What kind of doctor should I see if I am having problems with ingrown toenails, bunions, or heel pain?
Podiatrist
If we need urgent assistance, who do we reach out to?
ECM Leader or Clinical Consultants if applicable
What is the name of the EMR we use?
eClinical Works (ECW)
What are ECM's 7 core services?
1. Outreach and Engagement
2. Comprehensive assessment and care management plan
3. Enhances coordination of care
4. Health Promotion
5. Comprehensive transitional care
6. Member and family supports
7. Coordination of and referral to community and social supports
Who do we send all these forms:
1. Population of Focus Screening Checklist
2. Exclusionary Screening Checklist
3. ECM Referral Form
plus any additional medical documents...
ECM Program Manager - Paulette Din
What kind of doctor is the #1 doctor to reach out if member is expressing concerns?
What other Titanium Staff resources do we have?
1. Clinical Consultants
2. Resource Specialists
3. Housing Navigators
4. Mental Health Specialists