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
Member
A person who is receiving services through a certain program, such as a Minnesota Health Care Program or Medicare.
Minnesota Medical Assistance
Minnesota Medical Assistance is Minnesota's largest health care program and serves children and families, pregnant women, adults without children, seniors and people who are blind or have a disability. It is Minnesota’s Medicaid program for people with low income.
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.
