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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-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
What is it called when a new membership and future transfers are processed?
Month End Processing
What do theĀ 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
ID
242203
Card Set
Quiz 2 Med-cal Managed Care
Description
Quiz 2
Updated
2013-10-22T22:14:24Z
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