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What does AEVS stand for?
Automated Eligibility Verification System
When looking up a member in AEVS, you verify the month the member was dis-enrolled first True or False?
What date is entered in the "Issued date"?
What do the signal lights mean?
- Red light: No recorded eligibility
- Yellow light: Members enrolled in manged care
- Green light: Members on Fee For Service
What does CBAS mean?
Community Based Adult Service
CBAS is a program to place seniors into a Long Term Institution? True or False
what is ECM
Enhanced Care Management
All of our members automatically qualify for CBAS or ECM? True or False
Medi/Medi members who have 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?
A. A and D
(this multiple choice question has been scrambled)
Members who have only Medicare Part B and Medi-Cal will be assigned to:
Healthy Families who were with our Plan Partners will transition to Medi-Cal on
April 1, 2013
What is the transition aid code given to former HF members who have to pay a premium under Medi-Cal
Can a member in the "targeted Low-Income Children's Program (TLICPS) to be terminated from the program due to non payment?
Yes, if they have missed two payments the DHCS will try to find a program they qualify under if unsuccessful the will be terminated.
Name the payment options that members in the TLICP have?
- They can pay monthly
- Pay 3 months in Advance and receive get 1 month free
- Have automatic payments taken from their checking account and receive 25% discount
Explain the dental program for members in the TLICP program:
If they were enrolled into a Medi-Cal Dental Managed Care plan they will remain with the 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 receive their vision care?
Vision Service Plan (VSP)
Whats is the maximum co-payment a family will pay within one benefit year?
What is the income break down for the families who may or may not have to pay a premium in the TLICP program?
- 0 -150% of the FPL pay no premiums
- 151% - 250% of FPL have a premium of $13.00 per child up to 3 children
What is Health Integrated?
Is an agency who is contracted with LA Care to assist with UM services, such as out of area, inpatient and out patient and low level of care