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What is Preventative care?
When you see the doctor for non sick visits; It includes regular regular check-ups and treat illness before it becomes and requires emergency care.
What is emergency care?
Emergency care is life-threatening; a member needs to see the doctor right away for things like heavy bleeding, breathing problems and sever pain
What is urgent Care?
urgent care is needed when a person needs to see a doctor right away for treatment but illness or injury isn't life-threatening
When should a new member receive their Initial Heath Assessment (IHA)
under 18 months within 60 days and 18 months and older -120
What does SPD mean
Seniors and people with disability
What kind of transportation is covered under MCLA?
Named the Carved-out Medi-Cal services
- 1.Dental up to 21
- 2.Mental Health
- 3.Family Planning
- 4.Alcohol/Drugs abuse
- 5.Clinical testing
- 6.STD testing
- 7.HIV testing
- 9.Major organ transplant
What is it called when a new membership and future transfers are processed?
Month End Processing
What do the Plan Partners and Medical groups receive telling them who their members are?
Plan Partners= ETO
Name ten threshold languages?
Pharmacy is what type of benefit?
Name the 3 type of dis-enrollment out of Medi-Cal Managed care
- Moved out LA County
- Medical Exemption
- Plan Initiated
Name the 10 benefits under Medi-Cal
- Preventative care
- Urgent care
- doctors visit
- hospital care
- emergency care
- health education
- physical therapy
- speech therapy
- occupational therapy
Name 4 type of grievances
how can a member express their dissatisfaction?
- Writing, visiting, faxing, or calling LA Care
- Filing grievance a online with LA Care website
- Filing grievance form at the doctors office
- Ask for state fair hearing
What is it when a member is informed of all procedures, including grievances?
What come in a Welcome Packet ?
- Welcome letter
- Provider directory
- Privacy Practice Noticed
- LA Care Magnet
- ID Cards
A new member receives a welcome packages how long after the first of the month?
7 to 10 business days from the 1st of the month
Protected Health Informations
What is it when member must follow the doctor advice and take part in their care.