2015 Smmc Verification Procedure Questions

25 Questions | Total Attempts: 65

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2015 Smmc Verification Procedure Questions

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Questions and Answers
  • 1. 
    Sirena Robinson calls to verify what plan she and her newborn is enrolled in.  When the counselor tells her she is not the authorized person on the case she states she has been emancipated from her mother.  Which statement is correct? 
    • A. 

      The counselor can continue with the call because Stacie stated that she is emancipated.

    • B. 

      The call cannot continue because Stacie is under 18 years of age and counselors are never allowed to speak to members who are under age 18.

    • C. 

      The counselor should notify Stacie that legal documentation of her emancipation must be faxed in before she can speak for herself; she can continue the call on the newborn's behalf.

    • D. 

      Stacie must contact DCF to have a note placed on her case stating that she is emancipated.

  • 2. 
    Ericka calls in to verify her son's eligibility.  She does not have the PIN. How do you proceed?  
    • A. 

      Inform the mother that she must send in a signed copy of the Designated Authorized Representative form. Refer the caller to the SMMC website to obtain the DAR form and continue the call.

    • B. 

      Verify the address, member's name, and year of birth. If mom passes verification, continue with the call.

    • C. 

      Inform the mom that the caller must call in and authorize her to speak on his behalf.

    • D. 

      Do not continue with the call because mom is not the legal guardian/power of attorney.

  • 3. 
     If the member calls in for themselves and verifies all their information but then wants another person to speak on their behalf, how should you proceed?
    • A. 

      Document the person's Name, year of birth, and address and continue the call.

    • B. 

      Inform the recipient that you can only speak to the person who verifies the case and continue the call with the recipient.

    • C. 

      Continue the call. Once the recipient verifies their information, they can authorize someone else to speak for them.

    • D. 

      Ask the person to send in a copy of the DAR form authorizing them to speak on the member's behalf and continue the call.

  • 4. 
    Rosa calls to make a plan change for her granddaughter Sierra who is 19 years old. She does not have the PIN.  The grandmother states she is the child's Power of Attorney. How should you proceed? 
    • A. 

      Advise Rosa to contact DCF to update the payee. Do not continue the call.

    • B. 

      Do not continue with the call. Advise Rosa that a DAR form must be on file in order for her to be authorized.

    • C. 

      Tell Rosa to send in a signed copy of the DAR form or the legal documentation and continue the call.

    • D. 

      Inform Rosa that her granddaughter can only speak for herself.

  • 5. 
    Teresa Sullivan is calling to make a plan change for herself. After verifying her year of birth, she verifies her mailing address, but can not verify her physical address. How should you proceed?
    • A. 

      Advise Teresa that she cannot change her plan.

    • B. 

      Continue with the call. Do not refer Teresa to DCF/SSA to update the address because she verified at least one address on the case.

    • C. 

      Advise Teresa that she needs to submit proof of residence through AHCA.

    • D. 

      Ask for the county. If the county is verified, continue with the call and refer to DCF/SSA for the address update.

  • 6. 
    Roger Guiness is calling to enroll his mother Alice Munro into a LTC plan. He states he has Power of Attorney to speak on her behalf. How should the agent proceed?
    • A. 

      Since Roger volunteered that he has Power of Attorney for his mother, the agent may continue with the call without asking any verification questions.

    • B. 

      Continue with the call if Roger is listed as the payee on the case.

    • C. 

      Advise Roger to fax in legal documentation (POA), complete verification, and continue with the call.

    • D. 

      Advise Roger that his mom should speak for herself.

  • 7. 
    Keith Collins is calling to enroll his newborn child into a plan. Keith is 15 years old. Can the agent continue with the call?
    • A. 

      No, because underage parents cannot enroll their children.

    • B. 

      Yes, underage parents can call to enroll their children.

    • C. 

      No, only underage mothers are allowed to call in for their newborns.

    • D. 

      No, because Keith is not listed as the payee on the case.

  • 8. 
    Justin Taylor is calling to enroll his wife Brittany into a plan. He cannot verify Brittany's correct year of birth. How should  you proceed?
    • A. 

      Ask Justin for the last 5 of his wife's SSN. If he gets it right, continue with the call.

    • B. 

      Ask Justin to fax in the DAR form authorizing him to speak for Brittany.

    • C. 

      If Justin is on the case, verify his personal information and continue the call.

    • D. 

      Since Justin can not verify his wife's year of birth, do not continue with the call.

  • 9. 
    Jeremy Spencer is calling to enroll himself into United Healthcare of Florida. Is the agent still required to ask him if he has authority or permission to obtain information or make changes for himself?
    • A. 

      Yes, because if the agent skips the question, it will result in a prohibited activity.

    • B. 

      Yes, because all callers must state they have authority to make changes or obtain information for the person(s) they are calling for, even if they are calling for themselves.

    • C. 

      Yes, because AHCA requires that all callers answer that question.

    • D. 

      No, the agent may skip that question if they are calling for themselves.

  • 10. 
    Robert Robinson is calling for his older sister Susanne Robinson.  He has the Security PIN.  Do not ask Robert if he has authority or permission to obtain information or make changes for the person is calling for today.
    • A. 

      True

    • B. 

      False

  • 11. 
    How do you proceed if the caller does not have the security PIN and is calling for a member over 18. Check all that apply.
    • A. 

      Ask the caller if they have authority or permission to obtain information or make changes for the person they are calling for.

    • B. 

      If the caller states they have the authority, inform the caller to send in a signed copy of the DAR form (if needed).

    • C. 

      Ask the caller for the name, year of birth and physical address for one of the persons they are calling for and continue with the call.

  • 12. 
    The caller verifies the address correctly but gives you additional information for the street address that is not listed on the case, how should you proceed? 
    • A. 

      Continue with the call. Refer the caller to the DCF/SSA to update the address.

    • B. 

      Verify the last 5 of the member's SSN. Continue with the call.

    • C. 

      Refer the caller to the DCF/SSA to update the address. Do not continue.

    • D. 

      Continue with the call if the caller can verify the county.

  • 13. 
    Caller verifies: 1061 10th Street, Pompano,  33069. How do you proceed? 
    • A. 

      They pass address verification; continue with the call.

    • B. 

      Ask the caller to verify the complete address including the state.

    • C. 

      Refer the caller to DCF/SSA to update the address. Do not continue the call.

  • 14. 
    If the member verifies a new address in a DIFFERENT region...
    • A. 

      Process an enrollment/plan change. Tell the caller they may not receive their mail and refer to DCF/SSA to update the address.

    • B. 

      Ask for the county. If the county is verified, continue the call.

    • C. 

      Do not process an enrollment/plan change. Assist with case specific questions and refer to DCF/SSA to update the address.

    • D. 

      Ask for the last 5 of the member's SSN. Continue the call.

  • 15. 
    If the member verified a new address in the SAME region...
    • A. 

      Ask for the last 5 of the member's SSN. Continue the call.

    • B. 

      Process an enrollment/plan change. Tell the caller they may not receive their mail and refer to DCF/SSA to update the address.

    • C. 

      Do not process an enrollment/plan change. Assist with case specific questions and refer to DCF/SSA to update the address.

    • D. 

      Ask for the county. If the county is verified, continue the call.

  • 16. 
     For verification, agents must always ask for the full physical address first, the county is only a substitute if caller cannot verify physical address on file. 
    • A. 

      True

    • B. 

      False

  • 17. 
    When a name is listed in the address field with C/O (in care of)...
    • A. 

      The caller must still follow the normal verification procedures.

    • B. 

      They are automatically authorized.

    • C. 

      The caller must fax in legal documentation.

  • 18. 
    If the member is calling for themselves, is it necessary to ask for the Security PIN?
    • A. 

      No. The member is automatically authorized for themselves.

    • B. 

      Yes. Ask every caller for the security PIN.

    • C. 

      No. The security PIN is only required for cases with multiple members.

    • D. 

      Yes. The caller may not really be the member.

  • 19. 
     If the member calls in for themselves and verifies all their information but then wants another person to speak on their behalf, how should you proceed?
    • A. 

      Document the person's Name, DOB, and address and continue the call.

    • B. 

      Inform the recipient that you can only speak to the person who verifies the case and continue the call with the recipient.

    • C. 

      Continue the call. Once the recipient verifies their information, they can authorize someone else to speak for them.

    • D. 

      Ask the person to send in a copy of the DAR form authorizing them to speak on the member's behalf and continue the call.

  • 20. 
    If the caller has a DAR on file, are they still required to fax in another signed copy every time they call in?
    • A. 

      Yes. The caller is required to agree to fax in documentation on every call.

    • B. 

      No. The caller is only required to have one DAR on file. This DAR will apply for any member the caller calls in for.

    • C. 

      No. Once faxed in, the document will be added to HealthTrack and the caller does not need to fax in another copy. If the document has an expiration date that has expired, then the DAR must be faxed again.

    • D. 

      Yes. This ensures the member will always have an updated DAR on file.

  • 21. 
    If a Confidentiality Code appears in the address field, the caller has to verify it in order to pass verification?
    • A. 

      True

    • B. 

      False

  • 22. 
    Scenario:  Ms. Janis is calling for her 8 year old grandson Tom.  She provides the PIN and verifies all of Tom's personal information.  Ms. Janis also needs to send in a DAR form to prove she has authority over Tom.
    • A. 

      True

    • B. 

      False

  • 23. 
    DCF or CBC workers must:
    • A. 

      Must meet with a Field Choice Counselor to provide documentation on how they are authorized.

    • B. 

      Call AHCA to be added as the payee on the case to be authorized.

    • C. 

      Fax a DAR form to be authorized on the case.

    • D. 

      Complete verification and provide their Name, Agency & Title, Work phone number, and provide detail on how they are authorized to make decisions for the child.

  • 24. 
    Scenario:  Sue is calling for her elderly mother that suffers from dementia and recently had a stroke.  Sue states she is now caring for all of her mother's affairs.  How should you proceed?
    • A. 

      Tell Sue to place her mom on the phone to verify the personal information and then authorize Sue to speak on her behalf.

    • B. 

      Tell Sue about the DAR form and how to send it in so it can be added to the case and continue with the call.

    • C. 

      Tell Sue she must fax in the DAR before case information can be provided, do not continue the call.

    • D. 

      Tell Sue to call SSA/DCF to be added as the payee on the case.

  • 25. 
    If the caller has no idea about the PIN, how should you proceed?
    • A. 

      Tell the caller to look for the letter and call us back.

    • B. 

      Tell the caller you can reset the pin after verification is completed.

    • C. 

      Tell the caller it is the same PIN used by DCF.

    • D. 

      Tell the caller to call DCF for their PIN number.

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