Quiz 2 Med-cal Managed Care

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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?

Emergency Transportation
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
- 8.CCS
- 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

Medical Group=E-List
Name ten threshold languages?
- English
- Spanish
- Chinese
- Korean
- Vietnamese
- Armenian
- Tagalog
- Russian
- Cambodian
- Farsi
Pharmacy is what type of benefit?

Facility service
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
- Pharmacy
- Ancillary
- emergency care
- health education
- physical therapy
- speech therapy
- occupational therapy
Name 4 type of grievances
- clinical
- administrative
- provider
- pharmacy
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?

Members rights
What come in a Welcome Packet ?
- Welcome letter
- Provider directory
- EOC
- 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
PHI means?

Protected Health Informations
What is it when member must follow the doctor advice and take part in their care.

Member's responsibility

Author

Vsuberville

242203

Card Set

Quiz 2 Med-cal Managed Care

Description

Quiz 2

Updated

2013-10-22T22:14:24Z