A network gap is identified as:

An identified provider or facility on the Preclusion List is exempt from receiving Medicare payments for 90 days from the date being added to the list.

While on vacation in Colorado, a member fills a prescription at the CVS Pharmacy near their resort.  This pharmacy will be considered out-of-network due to its location.

If a member calls in on September 9th to change their PCP to a new provider, when will the change be effective?

A member is calling on February 3rd after an ER visit the night before.  They were advised to follow up with their PCP within 1 week of being seen at the ER, but state they'd like to use a new PCP.  What type of PCP change can we consider for the member?

A member calls on June 23rd.  They are requesting to change their PCP as they would rather have a female doctor.  They would like to schedule their annual wellness check-up in the fall with the new PCP.  What type of PCP change will we process and what would be the effective date of the change?

Which command path would you enter in CSIM to change a member's PCP?

Always offer a member at least ______ provider options, unless the caller requests otherwise.

When using the NAP tool, use the member's ____________ to identify the assigned network.

Drop the provider in the correct category.

On the NAP tool, what does Fee For Service (FFS) mean?

Which STC will you use to send a member a printed Provider Directory?

As a best practice, you should only submit requests for a printed Provider Directory for a 15 or 30 mile radius from the member's zip code.

ICRs must advise members they will receive a printed Provider Directory in:

ICRs must advise members they will receive their updated ID with the new PCP in:

Members calling for assistance locating a provider should also be educated on the self-service option of the Provider Search Tool on the CarePlus member website.

An ICR can look up an active, participating provider by using:

As a best practice, you should always type in the first 3 letters of the specialty type when using the CarePlus Provider Search Tool.

The CarePlus Provider Search Tool can be filtered by all of the listed types except:

A PCP's role in an HMO plan is to act as a gate-keeper who provides initial and ongoing care, referring to specialist for advanced or specialized care, if needed.

Capitation is:

Link the term to its definition.