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Medicaid CA

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  • What is the timeframe a member has to file a expedited Appeal?
    60 calendar days from date Auth was denied
  • what services are IPA groups responsible for?
    All professional services a member receives
  • what is the TAT for a standard CA Medicaid grievance?
    5 days to acknowledge 30 days to resolve
  • What does IPA stand for?
    Independent Practice Association
  • when assisting member with scheduling an appointment when should a second opinion appointment be scheduled?
    within 30 calendar days of the request
  • If a member calls in to change PCP on June 12th and has accessed care what will you choose for effective date
    you would not change it you would reach out to the lead line
  • What is CA Medicaid also known as?
    Medi-Cal
  • What does AVES stand for
    Automated Eligibility Verification System
  • What is considered a Facility service?
    Hospital, Pharmacy, or skilled nursing facility
  • where would you go to look up a CPT code to see if it needs a PA
    custom links, or Molinahealthcare.com
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