CCM Financial & Benefits Navigation Flashcards
6 cards from real CCM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CCM Financial & Benefits Navigation flashcards as text
Which government program provides health coverage to low-income children, pregnant women, elderly adults, and people with disabilities in the US?
Answer: Medicaid
Medicaid is a joint federal-state program providing health coverage to eligible low-income populations including children, pregnant women, elderly, and disabled individuals.
The Children's Health Insurance Program (CHIP) is designed to cover:
Answer: Children in families with incomes too high for Medicaid but who cannot afford private insurance
CHIP fills the gap for children whose family incomes exceed Medicaid limits but are still too low to afford private coverage.
A CCM case manager is helping a client navigate a prior authorization denial. The appropriate next step is to:
Answer: File an appeal using clinical documentation supporting medical necessity
Appealing with supporting clinical documentation to establish medical necessity is the standard process for challenging prior authorization denials.
The Affordable Care Act (ACA) marketplace special enrollment period (SEP) is triggered by which of the following?
Answer: A qualifying life event such as job loss, marriage, or having a baby
Qualifying life events — including loss of coverage, marriage, birth/adoption, or moving — trigger a Special Enrollment Period outside the annual open enrollment window.
Pharmaceutical patient assistance programs (PAPs) are primarily offered by:
Answer: Drug manufacturers to provide free or reduced-cost medications to qualifying patients
Pharmaceutical manufacturers operate PAPs to provide medications at no or low cost to uninsured or underinsured patients who meet eligibility criteria.
When a client is hospitalized, the case manager's financial navigation role includes:
Answer: Screening for financial assistance programs and coordinating discharge to prevent unplanned readmissions driven by cost
Case managers identify financial barriers to discharge and connect clients with assistance programs to support safe, sustainable transitions home.