CHC-MCO 2 July 20, 2020 admin Leave a comment Welcome to your CHC-MCO 2 1. Explain what is CHC or Community Health Choices? 2. What is Health Choices? A. PA's optional managed life care program for Medicare participants B. PA's mandatory managed care program for current medical assistance (Medicaid) participants C. A combination of 3 major MCO's old age program for PA residents 3. What is MCO? A. Mothers care organization supporting all mothers needs all over america B. Managers care organization offers residents of PA limited healthcare support C. Managed care organization group of health care industry companies and professionals 4. What are the 3 Major MCO's in PA? A. Keystone first VIP CHC Gateway Health Plan Delaware B. Highmark BCBSD Health Options BCBS MCO Delaware C. Amerihealth Caritas CHC PA Health & Wellness UPMC CHC 5. State and elaborate the similarities and differences of CHC & Health choices. 6. Which among the 3 major MCOs require pre-authorization for DME? A. All 3 MCO requires pre-auth B. None requires pre-auth C. Amerihealth-if in excess of 300 a month for diapers, pull ups or combination of both 7. What is the function of clearing house? A. Filters claims for mistakes. Misinformation and reject them without returning back the claim. B. Blocks claims for random checking C. Checks the claims for errors, corrects them before sending them back to insurance/payer 8. What are the filling method we use for the 3 major MCOs? A. MCOs uses different filing methods B. MCOs don't use other filing methods other than the traditional manual submission C. All 3 MCOs uses electronic method through provider portal 9. For the 3 major MCOs. What is the fee schedule we follow? A. All 3 MCOs follow Medicaid 100% fee schedule B. All 3 MCOs follow 200% Medicaid fee schedule C. UPMC-110% PA Medicaid. PAHW-100%.Amerihealth PA=100% PA MEDICAID 10. For Amerihealth. How many days is the validity of pre-authorization? A. 90 days B. 180 days C. 60 days Time's up
