CSV Week Crossword Puzzle

9. This is published quarterly by Member Services for our members
11. The Alliance’s PBM system
12. The Alliance uses __________ process to investigate members’ clinical concerns and take action when their expectations of care are not met. (acronym)
13. Members can call ________ (acronym) to talk to a nurse 24/7
14. This department evaluates physical access inside and outside the clinics for our seniors and persons with disabilities. (acronym)
16. Medi-Cal members can submit a ___________ request if they need to go to their doctor’s appointment but have no way to get there.
17. This team within Provider Services delivers high-quality and comprehensive customer service to providers.
18. Providers may file ________ with the alliance if they disagree with adjudication of a claim, or a utilization management decision made after services have been provided to a member.

1. This request from providers includes medical information that demonstrates that the requested service or equipment is medically necessary.
2. This department reviews and develops formulary quarterly
3. This person routes hundreds of incoming calls to our main business line, check in visitors with a friendly smile, and support a wide variety of staff needs.
4. Care management team provides ________ care to set goals, identify needs and address barriers for our members.
5. This benefit (acronym) was only available for EPSDT children but recently became available for all Medi-Cal members
6. Members may file a ____________ if they are dissatisfied with a decision the Alliance has made, or are concerned about the quality of care or access to services provided to them.
7. This department answers 90% of their calls within 20 seconds or less
8. To consistently provide exceptional customer service in a caring, timely and efficient manner.
10. One of Provider Services’ functional units
15. You can request ___________ evaluiation from the Facilities & Administrative services if you are uncomfortable at your work station