An advance directive puts your choices for health care into writing.
This is helpful in case you are not able to communicate your wishes.
Appeal
A way for you to challenge our action if you think we made a mistake.
You can ask us to change a coverage decision by filing a written or
oral appeal.
Application
A formal request for benefits made to the agency in writing and
signed by the applicant or someone acting on behalf of the applicant.
Application may be received by mail, phone, fax, in person, or electronically.
E
Emergency
A medical emergency is when you, or any other person with an average
knowledge of health and medicine, believe that you have medical
symptoms that need immediate medial attention to prevent death, loss
of a body part, or loss of function of a body part or could cause
serious physical or mental harm. The medical symptoms may be a serious
injury or severe pain. This is also called Emergency Medical
Condition.
Emergency Room
Emergency rooms (ERs) are for major injuries or sudden sicknesses
that may be life-threatening and need medical care right away. In an
emergency, you should call 911 or go to an ER immediately.
F
Fraud
The willful intent to obtain ineligible benefits or payments.
G
Grievance
A complaint you make about us or one of our network providers or
pharmacies. This includes a complaint about the quality of your care.
H
Hearing
A hearing is when you ask your health program to review your case
after your plan denied your appeal.
I
Inpatient Hospital Stay
A stay in a hospital or treatment center that usually lasts 24 hours
or more.
L
List of Covered Drugs (LOCD)
A list of approved prescription drugs approved by the Minnesota
Family Social Services Administration.
M
Medicaid
The Minnesota Department of Human Services (DHS) is a state agency
that helps people meet their basic needs. It provides or administers
health care, financial help, and other services. DHS administers the
Medical Assistance (Medicaid) program through counties. For
information on Minnesota's Medicaid programs visit https://mn.gov/dhs/
Member
A person who is receiving services through a certain program, such as
a Minnesota Health Care Program or Medicare.
O
Outpatient Hospital Services
Services provided at a hospital or outpatient facility that are not
at an inpatient level of care. These services may also be available at
your clinic or another health facility.
P
Primary Care Provider (PCP)
Your primary care provider (PCP) is a doctor or other qualified
health care provider you see at your primary care clinic. This person
will manage your health care.
Provider
A qualified health care professional or facility approved under state
law to provider health care.
R
Redetermination
Periodic review of your family’s income and eligibility. During
redetermination, also known as renewal, you must submit proof of
current income and residency to verify your eligibility.
S
Social Needs
A need that is best addressed by resources out in the community. Your
Member Services Advocate can help you access services that will
address your social needs.
Specialist
A doctor who provides health care for a specific disease or part of
the body.
State Appeal (Fair Hearing with the state):
A hearing at the state to review a decision made by us. You must
request in writing. Your provider may request a state appeal with you
written consent. You may as for a hearing if you disagree with any of
the following:
a denial, termination, or reduction of services
enrollment in the Plan
denial of part or all of a claim
for service
our failure to act within required timelines
for prior authorizations and appeals
any other action
U
Urgent Care Centers
You can use these centers when it's not a life-threatening situation,
but you are sick or need medical care right away and your PCP is not
available. Urgent care centers are usually open in the evenings and on weekends.
V
Virtual Visit
Virtual visits connect you with a live doctor through a smart phone
or computer for non-emergent visits.
