California OONR Quiz for Students

What is the company code for California Geographical OONR plans?

• 100A

• 200C

• 300B

• 400D

Which of the following is in scope for California 200C Geographical OONR?

• Medicare/Medicaid

• CA HMO (Except for Mental Health Providers)

• CA Local

• Out of State Providers

What is the maximum drive time allowed for an in-network provider before an OONR can be granted?

• 30 minutes

• 45 minutes

• 1 hour

• 2 hours

Which type of surgery can not be approved for Geographical OONR?

• Heart Surgery

• Bariatric Surgery

• Eye Surgery

• Knee Surgery

• none of these

What must be confirmed before granting a Geographical OONR for a Certified Licensed Midwife for a DMHC member?

• The member's age

• Benefits and Cost

• The member's address

• The member's occupation

How many providers must be contacted to confirm availability before approving a Geographic OONR for a 200C member?

• 3

• 4

• 5

• 6

What is the initial approval period for a Geographic Out of Network Referral for 200C members?

• 30 days

• 60 days

• 90 days

• 120 days

What should be done if an in-network provider has appointment availability within 10 business days for a 200c member requesting a geographic out of network referral?

• Approve the OONR

• Deny the OONR

• Extend the search

• Contact more providers

What happens if the system cannot determine the Geographic Out of Network referral decision on the call for a 200C member?

• The process is canceled

• The system will display, ‘Out of Network Referral decisions cannot be determined. Do you need to follow up with the member?’ The system will auto-select ‘No’ and close the task

• The system will display, ‘Out of Network Referral decisions cannot be determined. Do you need to follow up with the member?’ The system will auto-select ‘Yes’ and prompt you to complete a promise action for the service request.

• The member is notified immediately

What should be done if a DMHC member expresses dissatisfaction with a Geographic OONR denial?

• Ignore the complaint

• Handle as an Exempt Grievance

• Approve the OONR

• Transfer the call to another department