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MMP Medical Benefits Nuiances

Quiz by tori.randolph@anthem.com

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39 questions
Show answers
  • Q1
    What is the definition of Podiatry as it pertains to MMP plans?
    Measurements and molds of the foot to develop inserts to relieve back pain
    Diagnosis, treatment, and prevention of conditions of human feet.
    Diagnosis and treatment of children below 18 years old
    300s
  • Q2
    What Compass service item should you consult for additional information about foot related benefits?
    Benefits / auth requirements (Podiatry Benefit)
    Additional Actions
    Authorization Search
    Get Member Information
    120s
  • Q3
    For TX, when are foot exams covered as a medical (not supplemental) benefit?
    When the member is being treated by a chiropractor for alignment concerns
    When the member has diabetes or other nerve related conditions
    When the member first joins the plan
    When the member has a flat foot
    120s
  • Q4
    As a supplemental benefit, when do TX members receive routine foot care?
    6 visits total in a 12 month period
    1 visit every 12 months
    1 visit every 3 months
    1 visit every 6 months
    120s
  • Q5
    T/F - Treatment of flat foot that is solely cosmetic in nature is covered with an authorization
    TRUE
    FALSE
    120s
  • Q6
    Name 2 things which ARE covered under the TX audiology benefit. (NOTE - this is not the only thing covered. A LOT is covered here)
    Cochlear implants (implanted hearing aids) when regular hearing aids are not appropriate; or up to $2,000 for hearing aids each year
    Up to 2 hearing aids and 2 back-up hearing aids each year (a total of 4 hearing aids each year)
    Unlimited visits for the fittings of hearing aids and up to 1 repair per month
    Up to 1510 to spend on hearing aids in a calendar year
    300s
  • Q7
    Which benefit should be quoted for hearing tests done by a physician, audiologist, or other qualified provider
    Audiology
    This is not covered
    Hearing Benefits
    Outpatient Services
    120s
  • Q8
    Name 2 things which ARE covered under the CA audiology benefit.
    Unlimited hearing exams per year
    Up to 1510 to spend on hearing aids, repairs over $25
    A maximum of 6 visits to a participating provider for fittings of hearing aids
    Up to 1510 to spend on hearing aids, repairs that cost less than $25.
    120s
  • Q9
    The $1510 maximum cap on hearing aids does not apply to california members who are…______________
    Very nice to customer service reps
    Enrolled in a delegated risk group
    on a waiver program
    Pregnant or in a nursing home
    120s
  • Q10
    Who is the vendor for CA audiology?
    Hearpro
    No vendors
    Miracle Ear
    Hearing Care Solutions
    120s
  • Q11
    Who is the vendor for TX audiology?
    Hearing Care Solutions
    Hearpro
    No Vendor
    Miracle Ear
    120s
  • Q12
    Do members have to use in network provides for OB-GYN services? (note - this KM doc is hard to find. Make sure you try with / without the - in OB-GYN)
    Yes
    No
    300s
  • Q13
    Is inpatient delivery covered for maternal members (Mommys-to-Be); and if so…what KM doc should I research more into?
    Yes; you should research on the authorization document for more info
    Yes, this is specifically stated in the OB-GYN topic in KM
    Yes; you should search "maternity" topic in KM
    No this is not covered, because Medicare is for the elderly.
    120s
  • Q14
    What is covered in a "well woman exam"
    This covers a PAP Smear and a routine pregnancy test
    routine or annual gynecological exam, which includes a Pap smear and pelvic examination, and sometimes a mammogram.
    This covers a mammogram only
    This covers a PAP smear only
    120s
  • Q15
    How frequently are well-women exams covered?
    Once every 6 months
    Once per Year
    Once every 48 months
    Once per lifetime
    120s

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