PME Review

How many questions are there in the HIPPA V& Tool?

• 2

• 4

• 6

• 8

What do you have to do before a member disenrolls?

• Just do it like Nike

• they cant they have to wait until open enrollment

• Market Specific: Just cause grievance

• No biggie they can just leave

who does a member have to call to update their address, DOB or income?

• The local Medicaid office

• The post office

• Their mom

• Kaylee

What is an example of a privacy breach?

• Mail sent to the wrong address

• Member gives pcp their ID number

• Member services wont give out social

• Talking to a member about themselves

What type of doctors can be a primary care provider?

• Dermatologist

• OBGYN

• Ears/nose and throat

• chiropractic

Which of these describer a physician contracted to a specific plan?

• Par (IN Network)

• Non Par

• Specialist

• Dude, idk

How many options do we want to give out to a member looking for a provider?

• 36

• 1

• 4-5

• 3

How are authorizations different than notifations?

• Notifications dont require medical necessity criteria

• Auths have no start or end date

• Authorizations are only for inpatient services

• Notifications are for therapy visits

Which of these describes an authorization?

• Transferable to any provider or time period

• Needed for only inpatient procedures

• Specific to date and provider

• We dont even do auths broooo

What information do you need to check the status of a members complaint?

• The provider the complaint is about

• the date it was submitted

• the name of the associate who completed it

• WE do complaints?