Marketplace | Baamboozle - Baamboozle | The Most Fun Classroom Games!

English 26 Public

Marketplace

Study Slideshow

You have VERIFIED Member has a PHI Form on file for the person you are speaking with, the Caller wants to change Members PCP , CAN YOU?

NO.. Only POA or Member may change PCP on an account

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IN HEALTH INSURANCE WORLD A "COMPLAINT" is known as what??

GRIEVANCE

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IN HEALTH INSURANCE WORLD A DENIAL EQUALS WHAT?

APPEAL

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If its NOT DOCUMENTED it________ __________!

DIDNT HAPPEN!

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You are making an outbound call and the member is unreachable you DOCUMENT, and close the case.

FALSE

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Consider the following greeting did this agent nail his opening? HI ! This is ANDY Calling from Molina Health Care of TEXAS may I speak to CLINTON BIXBY?

Only ask for your Member by their FIRST NAME. Full names are PHI.

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You ask your member if they mind taking a few minutes to complete a brief HEALTH RISK ASSESSMENT and they say sure,but I dont have time . Is there somewhere else I can complete it?

MYMOLINA self service member portal

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Your member confirms that her PCP we have on file is correct. What is your next question to her ?

Have you had an opportunity to make an appointment to see your routine care provider?

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Molina Health Care Transportation Department provide rides to active Medicaid members for PCP appointments

FALSE

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MEDCAID MEMBER has just moved to a new address she needs to report this to ________

state welfare office

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VISION BENEFITS are included for TEXAS MEDICAID members. TRUE/FALSE

TRUE

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A member asks " Will I receive ID Cards for my dependents ?

YES Molina Medicaid of TX issues ID cards for Each Member on Plan

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Does my MEDICAID ID card have my PCP name listed on it?

YES!

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Name 3 reasons we make WELCOME CALLS

Explain plan benefits*Make sure members know their PCP*Make sure welcome kit has been received. Help members pick a PCP, Offer to make PCP appointments

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Following the Caller Verification Grid you realize the member you are calling about is a minor. What do you do

This is < Representative’s First name> from Molina Healthcare. May I please speak to [the parent or guardian of] <Member First name>? 

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Your member agrees to do the member material survey. Where do you document their responses to the survey questions?

‘Member Material Survey’ tab in SFL

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