2015 Smmc Verification Procedure Questions

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  • 1/25 Questions

    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?

    • Since Roger volunteered that he has Power of Attorney for his mother, the agent may continue with the call without asking any verification questions.
    • Continue with the call if Roger is listed as the payee on the case.
    • Advise Roger to fax in legal documentation (POA), complete verification, and continue with the call.
    • Advise Roger that his mom should speak for herself.
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2015 Smmc Verification Procedure Questions - Quiz
About This Quiz

This quiz titled '2015 SMMC Verification Procedure Questions' assesses knowledge on handling member service inquiries in healthcare settings. It evaluates the ability to manage verification processes, understand legal documentation requirements, and ensure compliance with regulations.

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  • 2. 

     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. 

    • True

    • False

    Correct Answer
    A. True
    Explanation
    This statement suggests that when verifying information, agents should always ask for the full physical address first. The county can only be used as a substitute if the caller is unable to provide or verify the physical address on file. Therefore, the answer is true as it emphasizes the importance of obtaining the complete physical address before considering the county as an alternative.

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  • 3. 
    If a Confidentiality Code appears in the address field, the caller has to verify it in order to pass verification? - ProProfs

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

    • True

    • False

    Correct Answer
    A. True
    Explanation
    If a Confidentiality Code appears in the address field, it means that there is a requirement for the caller to verify it in order to pass the verification process. This suggests that the Confidentiality Code serves as a security measure to ensure that only authorized individuals are able to access or communicate sensitive information. Therefore, the statement "True" indicates that the caller indeed has to verify the Confidentiality Code for successful verification.

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  • 4. 

    DCF or CBC workers must:

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

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

    • Fax a DAR form to be authorized on the case.

    • 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.

    Correct Answer
    A. 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.
    Explanation
    DCF or CBC workers must 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. This is necessary in order to ensure that the worker is authorized to act on behalf of the child and make decisions regarding their welfare. It also helps to establish the worker's identity and contact information for communication purposes.

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  • 5. 

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

    • No, because underage parents cannot enroll their children.

    • Yes, underage parents can call to enroll their children.

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

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

    Correct Answer
    A. Yes, underage parents can call to enroll their children.
    Explanation
    The correct answer is that underage parents can call to enroll their children. This means that even though Keith is only 15 years old, he is still able to call and enroll his newborn child into a plan. There is no restriction on underage parents being able to make this call.

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  • 6. 

    If the member verified a new address in the SAME region...

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

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

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

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

    Correct Answer
    A. Process an enrollment/plan change. Tell the caller they may not receive their mail and refer to DCF/SSA to update the address.
    Explanation
    If the member verified a new address in the SAME region, the correct action is to process an enrollment/plan change. However, the caller should be informed that they may not receive their mail and should be referred to DCF/SSA to update the address. This ensures that the member's enrollment or plan change is processed correctly, but also alerts them to the potential issue of not receiving mail at the new address and provides them with the appropriate resources to update their address with relevant agencies.

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  • 7. 
    Caller verifies: 1061 10th Street, Pompano,  33069. How do you proceed?  - ProProfs

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

    • They pass address verification; continue with the call.

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

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

    Correct Answer
    A. Ask the caller to verify the complete address including the state.
    Explanation
    The answer is asking the caller to verify the complete address including the state because the given address only includes the street and zip code. In order to proceed with the call, it is necessary to have the complete address, including the state, to ensure accurate information and proper routing.

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  • 8. 
    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? - ProProfs

    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?

    • Advise Teresa that she cannot change her plan.

    • 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.

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

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

    Correct Answer
    A. Ask for the county. If the county is verified, continue with the call and refer to DCF/SSA for the address update.
    Explanation
    If Teresa is unable to verify her physical address, the best course of action is to ask for the county. If the county can be verified, the call should continue and Teresa should be referred to DCF/SSA to update her address. This ensures that Teresa's address can be properly updated and any necessary changes can be made to her plan.

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  • 9. 

    If the caller has no idea about the PIN, how should you proceed?

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

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

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

    • Tell the caller to call DCF for their PIN number.

    Correct Answer
    A. Tell the caller you can reset the pin after verification is completed.
    Explanation
    If the caller has no idea about the PIN, the appropriate course of action is to inform the caller that the PIN can be reset after verification is completed. This implies that the caller will need to go through a verification process in order to reset the PIN. This ensures that the caller's identity is confirmed before any changes are made to the PIN, providing security and preventing unauthorized access.

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  • 10. 
    When a name is listed in the address field with C/O (in care of)... - ProProfs

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

    • The caller must still follow the normal verification procedures.

    • They are automatically authorized.

    • The caller must fax in legal documentation.

    Correct Answer
    A. The caller must still follow the normal verification procedures.
    Explanation
    When a name is listed in the address field with C/O (in care of), it means that the person receiving the mail or package is not the intended recipient. Therefore, the caller must still follow the normal verification procedures to ensure that they are speaking to the correct person and that their request or inquiry is valid. Simply listing a name with C/O does not automatically authorize the caller or grant them access without verification.

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  • 11. 

     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?

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

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

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

    • 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.

    Correct Answer
    A. Continue the call. Once the recipient verifies their information, they can authorize someone else to speak for them.
    Explanation
    If the member calls in for themselves and verifies all their information but then wants another person to speak on their behalf, the appropriate course of action is to continue the call. Once the recipient has verified their information, they can authorize someone else to speak for them. This ensures that the recipient is aware and in control of who is speaking on their behalf, while also allowing for the possibility of assistance from another person if needed.

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  • 12. 
    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?  - ProProfs

    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? 

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

    • 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.

    • 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.

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

    Correct Answer
    A. 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.
    Explanation
    The correct answer is that 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. This is because even if Stacie claims to be emancipated, the counselor needs proper documentation to verify her status and allow her to speak on her own behalf.

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  • 13. 

    If the member verifies a new address in a DIFFERENT region...

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

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

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

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

    Correct Answer
    A. Do not process an enrollment/plan change. Assist with case specific questions and refer to DCF/SSA to update the address.
    Explanation
    If the member verifies a new address in a different region, the correct course of action is to not process an enrollment/plan change. Instead, the agent should assist the caller with any case-specific questions they may have and refer them to the appropriate department (DCF/SSA) to update their address. This is because the change in region may affect the member's eligibility or coverage, and it is important to ensure that the address is updated correctly in the system. Asking for the county and the last 5 digits of the member's SSN are not relevant in this situation.

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  • 14. 

     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?

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

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

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

    • 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.

    Correct Answer
    A. Continue the call. Once the recipient verifies their information, they can authorize someone else to speak for them.
    Explanation
    If the member calls in for themselves and verifies all their information but then wants another person to speak on their behalf, the correct procedure is to continue the call. Once the recipient has verified their information, they can authorize someone else to speak for them. This means that the person who initially called can give permission for another individual to speak on their behalf during the call.

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  • 15. 

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

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

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

    • 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.

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

    Correct Answer
    A. 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.
    Explanation
    The correct answer is 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. This means that as long as the DAR is valid and has not expired, the caller does not need to send in another signed copy every time they call in. However, if the DAR has expired, it needs to be faxed again to ensure that the member has an updated DAR on file.

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  • 16. 
    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?  - ProProfs

    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? 

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

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

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

    • Inform Rosa that her granddaughter can only speak for herself.

    Correct Answer
    A. Tell Rosa to send in a signed copy of the DAR form or the legal documentation and continue the call.
    Explanation
    The correct answer is to tell Rosa to send in a signed copy of the DAR form or the legal documentation and continue the call. This is because the grandmother claims to be the child's Power of Attorney, which means she has legal authority to make decisions on behalf of the child. By requesting the DAR form or legal documentation, it ensures that the grandmother's claims are verified before proceeding with any plan changes.

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  • 17. 

    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?

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

    • 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.

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

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

    Correct Answer
    A. No, the agent may skip that question if they are calling for themselves.
    Explanation
    The correct answer is "No, the agent may skip that question if they are calling for themselves." This is because if Jeremy Spencer is calling to enroll himself into United Healthcare of Florida, he does not need to ask himself if he has authority or permission to obtain information or make changes for himself. The question is only necessary when someone is calling on behalf of someone else.

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  • 18. 

    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? 

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

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

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

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

    Correct Answer
    A. Continue with the call. Refer the caller to the DCF/SSA to update the address.
    Explanation
    If the caller verifies the address correctly but provides additional information for the street address that is not listed on the case, the appropriate course of action is to continue with the call and refer the caller to the DCF/SSA to update the address. This ensures that the correct information is recorded and any necessary updates can be made by the appropriate agency.

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  • 19. 

    If the member is calling for themselves, is it necessary to ask for the Security PIN?

    • No. The member is automatically authorized for themselves.

    • Yes. Ask every caller for the security PIN.

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

    • Yes. The caller may not really be the member.

    Correct Answer
    A. Yes. Ask every caller for the security PIN.
    Explanation
    The correct answer is "Yes. Ask every caller for the security PIN." This is necessary because even if the member is calling for themselves, there is still a possibility that the caller may not really be the member. Asking for the security PIN helps to verify the identity of the caller and ensure the security of the information being shared.

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  • 20. 

    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.

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The statement is false because the scenario does not mention anything about Ms. Janis needing to send in a DAR form to prove she has authority over Tom.

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  • 21. 

    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?

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

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

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

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

    Correct Answer
    A. Since Justin can not verify his wife's year of birth, do not continue with the call.
    Explanation
    In this situation, it is important to prioritize the security and privacy of the individual's personal information. Since Justin cannot verify his wife's year of birth, it is not appropriate to continue with the call as it could potentially lead to unauthorized access to sensitive information.

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  • 22. 

    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?

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

    • 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.

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

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

    Correct Answer
    A. 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.
    Explanation
    The correct answer is to 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. This is the appropriate course of action because the DAR form is used to authorize someone to speak on behalf of another individual. Since Sue states that she is now caring for her mother's affairs, it is necessary to inform her about the DAR form and guide her on how to submit it. Once the form is received and processed, Sue will be able to continue with the call and discuss her mother's case.

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  • 23. 

    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.

    • True

    • False

    Correct Answer
    A. True
    Explanation
    The correct answer is True. The question states that Robert Robinson is calling for his older sister Susanne Robinson and he has the Security PIN. The question specifically states not to ask Robert if he has authority or permission to obtain information or make changes for the person he is calling for today. Therefore, it can be inferred that Robert is authorized to make the call and has the necessary credentials to access the information or make changes.

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  • 24. 
    Ericka calls in to verify her son's eligibility.  She does not have the PIN. How do you proceed?   - ProProfs

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

    • 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.

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

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

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

    Correct Answer
    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.
    Explanation
    The correct answer is to inform the mother that she must send in a signed copy of the Designated Authorized Representative form and refer the caller to the SMMC website to obtain the DAR form. This is the appropriate procedure to follow when the caller does not have the PIN. By providing the necessary information and directing the caller to the website, the mother can proceed with verifying her son's eligibility.

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  • 25. 
    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. - ProProfs

    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.

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

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

    • 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.

    Correct Answer(s)
    A. Ask the caller if they have authority or permission to obtain information or make changes for the person they are calling for.
    A. If the caller states they have the authority, inform the caller to send in a signed copy of the DAR form (if needed).
    A. 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.
    Explanation
    The correct answer is to ask the caller if they have authority or permission to obtain information or make changes for the person they are calling for. If the caller states they have the authority, inform them to send in a signed copy of the DAR form (if needed). Additionally, 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. This ensures that the caller has the necessary authorization and provides the necessary information to proceed with the call.

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Quiz Review Timeline (Updated): Sep 7, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Sep 07, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Mar 19, 2015
    Quiz Created by
    AHSFLTrainer

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