Final Q#2

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Final Q#2
2013-10-22 17:07:58


final review
Show Answers:

  1. What is preventative Care?
    When you see the Dr for non sick visits; it includes regular check-ups and treats illness before it becomes more serious.
  2. What is emergency care?
    It is a life threatening injury
  3. What is Urgen Care?
    A non-life threatening injury.
  4. When should a new member receive their Initial Health Assessment (IHA)?
    • under 18 months of age - 60 days
    • 18 months and older - 120 days
  5. What does SPD mean?
    Seniors and People with Disability
  6. What kind of transportation is covered under MCLA?
    Emergency transportation
  7. Name the Carved-Out MediCal services.
    • Dental (up to 21 yrs old)
    • Mental Health
    • Family planning
    • Alcohol/Drug abuse services
    • Clinical Testing,
    • STD and confidential HIV testing
    • California Children Services (CCS)
    • Major organ transplants
  8. What is the event called when new membership and future transfers are processed?
    Month End Processing
  9. What do the Plan Partners and the Medical Groups receive telling them who their members are?
    • Plan Partners - ETO list
    • Medical Gropus - e-list
  10. Name ten threshold languages?
    • English
    • Spanish
    • Chinese
    • Korean
    • Vietnamese
    • Armenian
    • Tagalog
    • Russian
    • Cambodian
    • Farsi
  11. Pharmacy benefit is what type of service?
    Facility service
  12. Name 2 typesof disenrollments out of MediCal Managed Care system.
    • Moved out of county
    • medical excemption
    • Plan initiated
  13. Name 10 benefits under MediCal
    • Preventative Care
    • Urgent Care
    • Doctor's visists
    • Hospital Care
    • Pharmacy
    • Ancillary Services
    • emergency Care
    • Health Education
    • Vision Services
    • Interpreter Services
    • Physical Therapy
    • Speech Thereapy
    • Occupational Therapy
  14. Name the four types of grievances
    • Mmber Clinical Grievance
    • Member Administratie Grievance
    • Provider Grievance
    • Pharmacy Grievance
  15. How can a member express their dissatisfaction?
    In writing, in person, fax, or by calling LA Care; at the DPSS office. They can also go online to LA Care's website, at their doctor's office and they can also ask for a State Fair Hearing.
  16. What is it when a member is informed of all procedures, including grievances?
    Member's Rights
  17. What comes in the Welcome Packet?
    • Welcome Letter
    • ID Card
    • Provider Directory
    • EOC
    • Privacy Practive Notice
    • LA Care Magnet
  18. A new member receives a Welcome Packages how long after the first of the month?
    7-10 business days from the 1st of the month.
  19. PHI means
    Protected Health Information
  20. What is it when a member must follow the doctor's advice and take part in their care?
    Member's responsibility