When looking up a member in AEVS, you verify the month the member was disenrolled first?
What do the signal lights mean?
Red Light - No reported eligibility
Yellow Light - Managed Care
Green Light - Fee For Service
What does CBAS mean?
Community Based Adult Services
CBAS is a program to place seniors into a Long Term Institution
False. its to keep them out.
What is ECM?
Enhance Case Management
All of our members automatically qualify for CBAS or ECM.
Medi/Medi member who has been approved for CBAS will:
Will not be assigned to a PCP and MediCare is the primary plan.
Which group code represents members receiving community day care services?
Members who have only MediCare Part B and MediCal will be assigned to:
Healthy Families (HF) who were with our plan partners will transition to MediCal on:
April 1, 2013
What is the transition aid code given to former HF members who have to pay a premium under MediCal?
Can a member in the "Targeted Low-INcome Children's Program (TLIFCP) be terminated from the program due to non-payment?
The state, DHCS will see if they qualify for any other MediCal program and if they do, they will place the child with that program; if the child does not then they will be terminated.
Name the payment options that members in the TLICP
After two missed payments, the member's circumstances will be evaluated by the state, DCHS dept will see if the member quilifies for any other MediCal program and if they do, the child will be placed with that program; if the child does not then they will be termintated.
Name the payment options that members in the TLICP have.
They can pay monthly
3 months in advance and receive 25% discount
automatic payments taken from their checking account
debit card or credit card and recieve a 25% discount
Explain the dental program for members in the TLICP program.
If they were enrolled into a MediCal Dental Managed Care (DMC) plan they will remain with that Dentist. If they were not enrolled into a DMC plan, then they will be enrolled into Denti-Cal.
Where will former Hf members go to recieve their vision care?
Vision Service Plan (VSP)
What is the max co-pay a family will pay within one benefit year?
What is the income break down for families who may or may nothave to pay premium in the TLICP program?
income of 0 - 150% of the FPL = $0.00
income of 151% - 250% of the FPL = $13.00 per child, up to 3 children.
What is Health Integrated?
It is an agency who partners with the Health Plans to deliver a variety of UM (utilization management) services, such as out of area inpatient and outpatient services and low level of care.