2017 Test Prep: Quiz 5

Social Security Administration

AHCA Medicaid Helpline

Provider Needs Eligibility Information

Department of Children and Families

Have to start the enrollment process to be eligible for the LTC program all over.

Be responsible for paying the plan for services received during the temporary loss.

Continue receiving services from the LTC plan for up to 60 days and cannot change plans.

Have the option to change to a different LTC plan if they choose to.

Check the list of Providers Not Taking Plans on the SMMC Tool Kit to verify if we have received an update regarding the provider. If the provider is not on the spread sheet, advise the caller to fax the letter with the recipient ID.

Check Health Track to see if the provider doesn't accept their plan at another location and attempt a GC1 plan change again. If denied, tell the caller they have to wait until open enrollment to change.

Tell the caller that if the Primary Care Provider is still listed in Health Track, then the plan hasn't released the doctor from their contract yet. Refer the caller to the health plan to verify how long it's going to take to remove the provider and update the list.

Do not attempt a Good Cause plan change since you already know that it's going to be denied. Tell the caller to call the plan to get an out of network authorization or to change her Primary Care Provider.

GC4

GC1

GC9

GC17

Pending Choice is when the recipient is not eligible, but can receive services regardless of their Medicaid eligibility status.

Pending Choice is when the recipient can choose to enroll and not start services until Medicaid eligibility has been approved.

Pending Choice is when the recipient can receive services from the plan while their Medicaid eligibility is being determined.

Pending Choice when the recipient is Medicaid eligible and has to wait to enroll into the LTC program.

No, they can never be a Primary Care Provider and a Specialist at the same time.

Yes, as long as the member states they see them for Primary care needs as well.

Yes, as long as they are listed as a Primary Care Provider.

Yes, because they are a doctor and can offer any medical services.

Tell Marisol to send the DAR form, provide her with the fax number and continue with verification.

Tell Marisol that she must have the pin number when calling for another adult and do not continue the call.

Marisol is authorized because she is the parent of Anamaris and because she is listed on the same case.

Tell Marisol that she must call DCF for a confidentiality code to be authorized to access her daughter's case information.