2015 Smmc Complaints Quiz

22 Questions | Total Attempts: 362

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2015 Smmc Complaints Quiz

Select the best answer.


Questions and Answers
  • 1. 
    Tito Rivera is calling to complain against his PCP because he has to wait too long in the doctor's office every time he has an appointment. What Encounter Method should the agent select in HealthTrack to process the complaint? 
    • A. 

      Individual Session

    • B. 

      AHCA

    • C. 

      Education Session

    • D. 

      Call

  • 2. 
    Maggie Fenn is filing a complaint and would like to add a different phone number as the Preferred Contact Method in HealthTrack. How should the agent proceed?                                                                                                                                                                        
    • A. 

      Select "Other" in the Follow-Up Information box and enter the new phone number in the space provided.

    • B. 

      Select Requested Follow-Up and then enter the new phone number.

    • C. 

      Refer to DCF/SSA to update that demographic information.

    • D. 

      Refer to ACHA Medicaid Helpline to update demographic information related to complaints.

  • 3. 
    The Affected Party Type is...
    • A. 

      The person or persons the caller is complaining against.

    • B. 

      The person or persons being affected by the issue or problem.

    • C. 

      The person or persons that constitute a third party liability.

    • D. 

      The person or persons that are the Target Party.

  • 4. 
    Under the Affected Party Type only these should be used:
    • A. 

      General Health Plans, Medical Issues, and Providers.

    • B. 

      AHCA, DCF, SSA and DOEA.

    • C. 

      Recipient, General Population, and Other.

    • D. 

      General Health Plans, General Population, Specialty Plans and Pharmacies.

  • 5. 
    "Recipient" is selected in HealthTrack when the affected person or persons are Medicaid recipients.
    • A. 

      True

    • B. 

      False

  • 6. 
    Bruce Goldman calls in and states he is a Community Based Worker representing several enrollees that want to file a complaint against Humana Medical Plan because the plan is not covering a prescription drug necessary for their treatment. What Affected Party should you select in HealthTrack?
    • A. 

      Recipients

    • B. 

      Other

    • C. 

      Target Party

    • D. 

      General Population

  • 7. 
    Rita Bailey calls in and states she wants to complain against her plan because she is being required to pay for services the plan is supposed to cover. What Issue Category should you select?
    • A. 

      AHCA

    • B. 

      Billing and Payment

    • C. 

      Marketing

    • D. 

      Network Access

  • 8. 
    The Issue Category is
    • A. 

      The Target Party

    • B. 

      The person or persons being affected by the issue or problem.

    • C. 

      What the caller is complaining about or who the caller is complaining against.

    • D. 

      The complaint category assigned to the person or persons filing the complaint.

  • 9. 
    Anita Stephens calls in to complain against an AHS Choice Counseling Specialist because the agent  was "rude" and "disrespectful" when she requested a plan change yesterday. How should you proceed?
    • A. 

      Escalate the call to a Supervisor for further assistance with the customer service issue.

    • B. 

      Submit a call back request to have a Supervisor assist Anita.

    • C. 

      Refer to AHCA Medicaid Helpline because they are required to process complaints against AHS.

    • D. 

      Process the complaint request through HeathTrack and provide Anita with the complaint number.

  • 10. 
    Jane Doe wants to file a complaint on behalf of her entire family including her son, Freddie Doe.  The agent looks in HealthTrack and sees that Freddie Doe is not listed on the case. How should the agent proceed?
    • A. 

      Add Freddie Doe by typing his name into the blank box below the names in the Affected Individuals section.

    • B. 

      Refer to ACHA Medicaid Helpline for further assistance in filing the complaint for non-listed members.

    • C. 

      Refer to DCF to add Freddie Doe to the case in order to process the complaint in HealthTrack.

    • D. 

      Create a task so that a supervisor may review the case and send the complaint to AHCA.

  • 11. 
    The Issue Categories are the same for all three Affected Parties.
    • A. 

      True

    • B. 

      False

  • 12. 
    Which of the following statements is true?
    • A. 

      All documentation submitted in HealthTrack is public record.

    • B. 

      Media, government officials and/or court may view documentation submitted through HealthTrack.

    • C. 

      Choice Counseling agents should always proof-read all of their notes for spelling errors, incorrect punctuation, and grammar.

    • D. 

      All of the above.

  • 13. 
    Shakira calls to complain against her doctor, the pharmacy and the plan. She wants to file all three complaints in the same call. How should you proceed? 
    • A. 

      Process one complaint for each single issue at a time. You should process three separate complaints for all the three issues.

    • B. 

      Inform Shakira that she must contact AHCA Medicaid Helpline for complaints related to multiple issues.

    • C. 

      Refer Shakira to her plan to file a grievance against all three providers.

    • D. 

      Process a complaint for one issue in HealthTrack. Once you are finished, add a new issue to the same complaint. Add as many issues as Shakira requests.

  • 14. 
    If a caller complaining against multiple issues decides to cancel one of those issues while he is with you on the phone, how should you proceed?
    • A. 

      Place the request on the Discrepancy Log.

    • B. 

      Remove the issue by clicking on the red X in the top right corner of the Complaint Wizard.

    • C. 

      Advise the caller that they should be sure before filing multiple complaints.

    • D. 

      Refer the caller to a supervisor for further assistance because once the issues are logged cannot be canceled.

  • 15. 
    Before closing the call, Rosita tells the agent that she wants to cancel the complaint she is filing against her specialist. How should the agent proceed? 
    • A. 

      Cancel the complaint by clicking cancel on the bottom left corner of the Complaint Wizard.

    • B. 

      Encourage Rosita to file the complaint.

    • C. 

      Complete the complaint without Rosita's authorization.

    • D. 

      Submit a request to have a Supervisor call back and further investigate the issue.

  • 16. 
    Each Issue Category will have a set of questions that must be answered to file the complaint.
    • A. 

      True

    • B. 

      False

  • 17. 
    Tommy filed a complaint against Molina Healthcare of Florida and asks the agent for a complaint number. How should the agent proceed? 
    • A. 

      Inform Tommy that agents are not allowed to disclose the complaint number and he will be notified by mail with a resolution to his complaint.

    • B. 

      Give the complaint number to Tommy.

    • C. 

      Refer Tommy to a supervisor because only supervisors may provide the complaint number.

    • D. 

      Advise Tommy that he needs to contact AHCA Medicaid Helpline to obtain the complaint number.

  • 18. 
    What do the tabs on the top of the Complaint Wizard mean?
    • A. 

      The caller is filling a complaint with multiple issues like General, AHCA and HIPAA.

    • B. 

      The tabs pop up just to let the agent know that the caller must file a complaint against General, AHCA and HIPAA.

    • C. 

      The agent must go over all three tabs to verify if the caller has any complaint pending against General, AHCA and HIPAA.

    • D. 

      The complaint must be sent to the General, AHCA and HIPAA for review.

  • 19. 
    Megan Ross is calling to follow up on a complaint she filed against her health plan. The agent sees in the case history in HealthTrack that the complaint status is 'In Progress' but there is no further information on the complaint's status. Megan is adamant about obtaining more information about her issue. Where should the agent refer Megan for further assistance?
    • A. 

      Refer to a Supervisor

    • B. 

      Refer to DCF/SSA/DOEA

    • C. 

      Refer to the health plan

    • D. 

      Refer to AHCA Medicaid Helpline

  • 20. 
    If the person is calling from a state agency such as DCF, APD, or AHCA which option would you select under 'Complainant'?
    • A. 

      Commercial Organization

    • B. 

      Authorized Agency

    • C. 

      Provider

    • D. 

      Health Plan

  • 21. 
    If a Mandatory recipient calls and states they want straight Medicaid, the agent should:
    • A. 

      Immediately advise the caller that is not an option and end the call.

    • B. 

      Advise the caller they are required to be in a plan to continue receiving services and ask what is their reason for wanting FFS/Straight Medicaid.

    • C. 

      Advise the caller the request will be submitted and they will have straight Medicaid the 1st of the following month.

    • D. 

      Submit the request to the supervisor for approval.

  • 22. 
    To remove  HIV/AIDS, SMI, or Freedom special conditions from a recipients case, the agent should:
    • A. 

      File a complaint in the complaint wizard.

    • B. 

      Select the MC EX/SC Request button in HealthTrack and document the request.

    • C. 

      Submit a task to a supervisor and request the removal.

    • D. 

      Contact the SNU and the request they remove the condition.

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