What does the Third Party Liability screen in MCS show you?
A.
The provider write-off amount (the amount of money the member is not liable to pay)
B.
Meridian enrollment data
C.
Family members connected to the account
D.
Other insurance the member has
2.
If a member's date of birth is incorrect in MCS, you should navigate to the demographics screen and update it.
A.
True
B.
False
3.
What is this button used for?
A.
Accessing Contact Reports
B.
Accessing CHAMPS
C.
Accessing Eligibility/PCP History
D.
Accessing Electronic Data in MCS
4.
Which screen in MCS would you navigate to if you needed to change a member's PCP?
A.
Eligibility/PCP History
B.
Member Management
C.
Demographics
D.
Care Team/Auth Rep
5.
How often is a member able to change his/her PCP?
A.
Once a month
B.
Once a day
C.
Once every quarter
D.
As often as they would like
6.
Is CPT E0217 covered by Meridian in Michigan?
A.
Yes, it is covered and does not require PA
B.
Yes, it is covered, but it does require PA to be submitted for review
C.
No, it is not covered by Meridian, but might be covered by the state of Michigan
D.
No, it is not covered by Meridian or the state of Michigan
7.
Is CPT code 30410 covered by Meridian in Michigan?
A.
Yes, it is covered and does not require PA
B.
Yes, it is covered, but does require PA to be submitted for review
C.
No, it is not covered by Meridian, but might be covered by the state of Michigan
D.
No, it is not covered by Meridian or the state of Michigan
8.
Is CPT code 99213 covered by Meridian in Michigan?
A.
Yes, it is covered and does not require PA
B.
Yes, it is covered, but will require PA to be submitted for review
C.
No, it is not covered by Meridian, but might be covered by the state of Michigan
D.
No, it is not covered by Meridian or the state of Michigan
9.
What is the Chiropractic benefit for a Michigan TANF member?
A.
18 visits per calendar year, must have approved PA on file
B.
18 visits per calendar year, PA required if OON
C.
Covered for members who are 20 and under only, but there is no benefit visit limit
D.
Covered for members who are 20 and under only, limited to 18 visits per fiscal year
10.
A Michigan member calls in requesting listings for a Psychiatrist in his/her area, you should...
A.
Advise the member that this Behavioral Health service is not covered through Meridian, but may be covered through the state of Michigan
B.
Advise the member that this Behavioral Health service is not covered through Meridian or the state of Michigan
C.
Locate Psychiatry listings in the member's area using the online provider search
D.
Advise the member that he/she should visit a Psychologist or Therapist instead, since Psychiatrists only spend 20 minutes with their patients
11.
Where should you navigate to if you need to locate your Medicaid Welcome Calls Job Aid
A.
CE Department Site
B.
CE Training Aids Library
C.
Prime Meridian
D.
mhplan.com
12.
What are the requirements for Bariatric Surgery?
A.
Member must prove 6 months of consecutive weight management
B.
Member must be a member for at least 1 year
C.
Member must have a BMI of 40 or grater
D.
Member must be at least 18 years old
13.
Which authorization form(s) need to be submitted to Meridian for a member to complete Weight Watchers?
A.
Online Prior Authorization Form (ePA)
B.
Weight Watcher's Letter of Commitment
C.
Appointment of Representative (AOR) Authorization Form
D.
Authorization for Release of Information Form
14.
Where should you navigate to if you need to find a list of providers that accept Meridian Health insurance?
A.
CE Department Site
B.
CE Training Aids Library
C.
Prime Meridian
D.
mhplan.com
15.
Which MCS button would you select to send a new ID card to a member?
A.
B.
C.
D.
16.
What will you code in the contact log if you check a CPT code for a member? (i.e. check coverage status and PA requirements in the CBT)
17.
What will you code in the contact log if you verify a member's PCP?
18.
What will you code in the contact log if you advise a member of a future termination date on his/her account?
19.
What will you code in the contact log if you transfer the caller to a different team/department?
20.
If you are submitting to NotifyMHP because a member is moving out of state, what will your Notification Type and Type of Action be?
A.
Enrollment; Eligibility Issue
B.
Case Management; Out-of-State Disenrollment
C.
Case Management; Eligibility Issue
D.
Enrollment; Out-of-State Disenrollment
21.
If you are submitting to Notify MHP because a member has a primary insurance that is not currently in MCS, what will your Notifcation Type and Type of Action be?
A.
Case Management; Coordination of Benefits
B.
Claims; Coordination of Benefits
C.
Case Management; Certificate of Coverage
D.
Enrollment; Coordination of Benefits
22.
If you are submitting to Notify MHP because a member needs to be enrolled into Care Coordination, what will your Notification Type and Referral Reason be?
A.
Case Management; Coord of Care
B.
Enrollment; Disease Managment
C.
Case Management; CC Enrollment
D.
Enrollment: Coord of Care
23.
Can a minor member have two parents listed on his/her Care Team Screen?
A.
Yes
B.
No
24.
If a member is unable to provide his/her Meridian ID number, we can ask for name, date of birth, and full mailing address to verify him/her.
A.
True
B.
False
25.
We can give provider listings to an unverified caller as long as they provide us with the zip code to look up the providers.
