Are They Authorized? (Verification Procedure)

1. Sandy Morgan calls in to enroll Michael Gordon into CMS. She states she is a case worker for the Department of Children and Families. How should the agent proceed?

Advise Sandy that she is not authorized on the case and you cannot continue with the call.

Advise Sandy that she must have authorization from Michael's parents to continue with the call and complete enrollment.

Advise Sandy to complete the Designated Authorized Representative form in order to continue with the call.

2. 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?

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.

3. 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.

4. 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 AHCA requires that all callers answer that question.

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

5. Robert Robinson is calling for his older sister Susanne Robinson. If he has the security PIN, it is not necessary to ask Robert if he has authority or permission to obtain information or make changes for the person he is calling for today.

True

False

6. Rosa calls to make a plan change for her granddaughter Sierra who is 19 years old. The grandmother states she is Sierra's Power of Attorney. How should you proceed?

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

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

Inform Rosa that her granddaughter can only speak for herself.

7. 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.

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

8. Sirena Robinson calls to verify the current plan for herself and her newborn child. 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 Sirena stated that she is emancipated.

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

9. Ericka calls in to verify her 19 year old son's eligibility. How do you proceed?

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

Inform the mom that her son 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.

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

Advise Teresa that she cannot change her plan.

Inform Teresa that she does not need to contact DCF/SSA to update her physical address.

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

11. Caller verifies: 1061 SE 10th Court Pompano Beach 33069. How do you proceed?

Just ask the caller for the county, we don’t need to verify the complete address.

Ask the caller to verify the state.

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

12. During verification, the caller states they have moved. The caller provides a new address that is in a DIFFERENT region than the address in HealthTrack. How should you proceed?

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.

13. During verification, the caller states they have moved. The caller provides a new address that is in the SAME region as the address in HealthTrack. How should you proceed?

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

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

14. 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.

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.

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