Quiz 2 Med-cal Managed Care

The flashcards below were created by user Vsuberville on FreezingBlue Flashcards.

  1. 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.
  2. 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
  3. 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
  4. When should a new member receive their Initial Heath Assessment (IHA)
    under 18 months within 60 days and 18 months and older -120
  5. What does SPD mean
    Seniors and people with disability
  6. What kind of transportation is covered under MCLA?
    Emergency Transportation
  7. Named the Carved-outĀ  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
    • 8.CCS
    • 9.Major organ transplant
  8. What is it called when a new membership and future transfers are processed?
    Month End Processing
  9. What do theĀ  Plan Partners and Medical groups receive telling them who their members are?
    Plan Partners= ETO

    Medical Group=E-List
  10. Name ten threshold languages?
    • English
    • Spanish
    • Chinese
    • Korean
    • Vietnamese
    • Armenian
    • Tagalog
    • Russian
    • Cambodian
    • Farsi
  11. Pharmacy is what type of benefit?
    Facility service
  12. Name the 3 type of dis-enrollment out of Medi-Cal Managed care
    • Moved out LA County
    • Medical Exemption
    • Plan Initiated
  13. Name the 10 benefits under Medi-Cal
    • Preventative care
    • Urgent care
    • doctors visit
    • hospital care
    • Pharmacy
    • Ancillary
    • emergency care
    • health education
    • physical therapy
    • speech therapy
    • occupational therapy
  14. Name 4 type of grievances
    • clinical
    • administrative
    • provider
    • pharmacy
  15. 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
  16. What is it when a member is informed of all procedures, including grievances?
    Members rights
  17. What come in a Welcome Packet ?
    • Welcome letter
    • Provider directory
    • EOC
    • Privacy Practice Noticed
    • LA Care Magnet
    • ID Cards
  18. 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
  19. PHI means?
    Protected Health Informations
  20. What is it when member must follow the doctor advice and take part in their care.
    Member's responsibility
Card Set
Quiz 2 Med-cal Managed Care
Quiz 2
Show Answers