Network Performance
Network Management
Credentialing
Network Data/Delegation
Potpourri
200
From the most to the least, which borough has the most par LHCSA’s and CDPAPs?
What is BK – 230; Queens – 92; Manhattan – 43; BX – 27; SI – 9
200
What is a NAMR?
What is Network Account Management Rep
200
A process by which an organization reviews and evaluates qualifications of licensed practitioners to service its members
What is Definition of Credentialing (NCQA)
200
The amount of times CPHL is required to submit the Provider Network to State Department of Health
What is quarterly / 4x a year ?
200
This federal entitlement program has been in place since 1965.
What is Medicare?
400
Name the difference between LHCSA and a CHHA (Certified Home Health Aide)?
what is CHHA can bill Medicare and LHCSA can only work with Medicaid, Private Insurance and Private Pay?
400
Helps individuals 21 years and older in New York State, coordinate and provide health care services to live safely at home for as long as possible.
What is MLTC (or Manage Long Term Care)?
400
Patient Safety, Risk Management Concerns, Required by Accrediting and Regulatory Agencies
What are Reasons for Credentialing?
400
Based solely on the number of unique NPI, this contract contributes the most to our network
what is MedImpact?
400
A fixed dollar amount payed to participating providers on a monthly basis to treat members.
What is capitation?
600
Acronym for CDPAP
what is Consumer Directed Personal Assistance Program ?
600
Although our mission is to keep the member safely home receiving services, there comes a time when the home is no longer deemed safe for the member needs. Where will they be placed ?
What is a Nursing Home Care?
600
Length of re-credentialing cycle
What is every 3 years to the month?
600
Name at least 3 facility-based specialty that contribute to Medicare adequacy.
What is...Acute Inpatient Hospitals, Cardiac Surgery Program, Cardiac Catheterization Services, Critical Care Services, Outpatient Dialysis, Surgical Services (Outpatient or ASC), Skilled Nursing Facilities, Diagnostic Radiology, Mammography, Physical Therapy, Occupational Therapy, Speech Therapy, Inpatient Psychiatric Facility Services, Outpatient Infusion/Chemotherapy
600
This form is used for individual practitioners to submit claims to a managed care organization.
What is a CMS-1500 pka HCFA?
800
Name at least 3 services Social Days Provide
What is Social Activities; Nutrition Services; Personal Care; Health Services; Transportation; Services for Caregivers ?
800
Two forms of cost sharing for Medicare
What is a deductible and coinsurance
800
Conduct that falls short of what a person would do to protect another from a risk of harm
What is Negligence?
800
This county is located in the northeastern section of NY. It is known for its rich valley farm land and is part of the Great Appalachian Valley (also known simply as the 'Great Valley')
What is Washington County?
800
The Article of the New York State Public Health Law that Centers Plan is certified.
What is Article 44?
1000
Name at least 2 kinds of people that are not allowed to be a personal assistant for a CDPAP
What is Children; Consumers Spouse; Consumer Designated rep; Parent of a disabled child under 21
1000
Which vendor has the most delegated functions
Who is Healthplex?
1000
Document that attests of the truth of certain facts or validates the authenticity of someone or something
What is Certification?
1000
These functions are delegated to our directly contracted hospitals (such as Northwell or NYU)
Credentialing, Provider Relations, & Data Management
1000
A document that broadly defines the way health services are delivered.
What is a Model of Care (MOC)?