2017 Test Prep: Quiz 5

7 Questions | Total Attempts: 158

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2017 Test Prep: Quiz 5

Answer the questions below. This will help you meet the new requirement of 86% passing grade. You may utilize available resources (ie. SMMC Tool Kit, Script, etc. )


Questions and Answers
  • 1. 
    Dr. Amy Smith calls to verify eligibility for Jon Doe. Where to you refer this call?
    • A. 

      Social Security Administration

    • B. 

      AHCA Medicaid Helpline

    • C. 

      Provider Needs Eligibility Information

    • D. 

      Department of Children and Families

  • 2. 
    For LTC plans, enrollees that have a "temporary loss" will
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 3. 
    A member has called several times and states their doctor will stop taking their current plan starting next month.  You look in HealthTrack and the PCP is still showing with the current plan, so the GC1 (Provider No Longer with Plan) is denied.  You explain this to the caller and they state they have a letter from the doctor's office that states the PCP is no longer taking the plan.  What should you do next?
    • A. 

      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.

    • B. 

      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.

    • C. 

      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.

    • D. 

      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.

  • 4. 
    For LTC, what is Pending Choice?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 5. 
    Caller is locked in and says: "The company that delivers my meals told me they will stop taking my plan next month. I really like them because they are always on time and they make good food. Can I change my plan to a plan they will take?" Which Good Cause would you use?
    • A. 

      GC4

    • B. 

      GC1

    • C. 

      GC9

    • D. 

      GC17

  • 6. 
    Can an OB/GYN doctor be a PCP?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

  • 7. 
    Marisol is calling for her daughter Anamaris, she does not have the PIN number, how do you proceed?
    • A. 

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

    • B. 

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

    • C. 

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

    • D. 

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

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