Lead Choice Counseling Specialist Interview
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- 1.The recipient changed the plan during the Lock-In period using a Good Cause 1. The plan change was approved and the new plan will become effective on 05/01/2015. When will the 90 day change period start?
- A.
08/01/2015
- B.
05/01/2015
- C.
07/01/2015
- D.
06/01/2015
- 2.Oscar Wilde changed his plan during his Open Enrollment period (5/6/2015 to 07/31/2015). When will his new plan start?
- A.
08/01/2015
- B.
09/01/2015
- C.
10/01/2015
- D.
11/01/2015
- 3.I am on Medically Needy Medicaid and need to know my share of cost. Who should I call?
- A.
SSA
- B.
Area Office
- C.
Health Plan
- D.
DCF
- 4.I was told I have a private insurance listed on my case, but I haven't had that for years, who do I call to take that off my case?
- A.
Area Office
- B.
DCF
- C.
The Insurance Company
- D.
TPL Corrections
- 5.
The recipient calls to make a LTC plan change. What are their options to receive services?- A.
They are not eligible to make a plan change because they are currently in a Nursing Home.
- B.
Can change plan to PACE only.
- C.
Can change into another available LTC plan.
- D.
They must keep the current American Eldercare plan.
- 6.
The recipient calls to enroll into a managed care plan. What are their enrollment options?
- A.
Only FFS because they are voluntary.
- B.
Cannot enroll into a plan because of an active TPL on file.
- C.
The recipient is voluntary because of the TPL on file and they have the options of remaining FFS or enrolling into a Health plan.
- D.
Only enroll into a plan and can not have FFS because of the TPL on file.
- 7.
Why is the recipient listed below Excluded from enrolling into a LTC plan?
- A.
Recipient is receiving Medicaid from the Social Security Administration.
- B.
Recipient has APD: IC meaning they are currently incarcerated.
- C.
Medicaid ended on 5/1/2010.
- D.
Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.
- 8.
Why is the recipient below categorized as Voluntary?
- A.
She has (LTCC) indicator next to her level of care.
- B.
She has APD: WL meaning she is on the Agency for Persons with Disabilities Waitlist.
- C.
She has ( MWA ) ACWM.
- D.
She has APD: WL meaning she is on the Weight Loss Waiver Program.
- 9.
Which tab below would indicate if the recipient has been pre-approved for CMS?
- A.
Special Conditions
- B.
Level of Care
- C.
Waiver Program
- D.
Eligibility
- 10.
The recipient calls to enroll into a plan. The agent informs the recipient they are not eligible to enroll into a LTC plan because they receive services through the Agency for Persons with Disabilites waiver .
- A.
True
- B.
False
- 11.
What does the "T" shown for the recipient's LTC coverage mean ?
- A.
The recipient's LTC coverage has been terminated and they are no longer receiving services.
- B.
The recipient experienced a temporary loss and must pay for services until coverage is reinstated.
- C.
The recipient has experienced a temporary loss and will continue services at no charge for 60 days.
- D.
The recipient is not eligible to be enrolled into a LTC plan
- 12.
The recipient's mother calls in to enroll her son into a plan. Is the recipient eligible to enroll into a managed care plan?
- A.
Yes, this recipient must be enrolled into a managed care plan
- B.
No, only recipient 18 and over can enroll into a Managed Medical Assistance plan
- C.
No, this recipient has an exemption
- D.
No, this recipient's Medicaid coverage ended on 1/1/2006
- 13.MMA plans must provide continuity of care for up to _________ days.
- A.
90
- B.
30
- C.
180
- D.
60
- 14.Caller states: "I just started my new plan and just remembered I have an appointment with my old doctor for a procedure. What should I do?" How should you proceed?
- A.
Tell the caller the appointment needs to be cancelled and and re-scheduled with the new plan.
- B.
Explain Continuity of Care and refer to the new plan for more information.
- C.
Tell the caller the previous plan will cover services for up to 60 days.
- D.
Tell the caller the appointment will not be covered because the provider is not part of the MMA plan.
- 15.
When did the member's current Medicaid HMO start?
- A.
05/01/2014
- B.
01/01/2013
- C.
03/01/2014
- D.
04/01/2013
- 16.
Did the member get auto assigned to the health plan or did they choose it?
- A.
Auto Assigned
- B.
Voluntary Choice
- 17.
When did the member's most recent Medicaid start?
- A.
12/1/2007
- B.
3/1/2009
- C.
5/1/2010
- D.
5/1/2009
- 18.
What should be selected to view the TPL address and phone number?
- A.
A
- B.
B
- C.
C
- D.
D
- 19.Caller is locked in and says: "I never picked this plan! You all put me in it! My doctor, that I really like, doesn't take this plan and has never taken it! I've been with the same doctor for years, I don't want to change." Which GC would apply?
- A.
GC1
- B.
GC8
- C.
GC1612
- D.
GC9
- 20.Caller is locked in and says: "I have HIV and my doctor told me to change to Clear Health Alliance / Positive HealthCare. I need that to start soon because all of my new specialists take that plan." Which GC would apply?
- A.
GC17
- B.
GC4
- C.
GC9
- D.
GC5
- 21.Caller is locked in and says: "Medicaid sent me a letter a while back with my open enrollment dates, but I forgot to call you to change my plan. I think the last day was last Thursday. I just want to change it because my sister said her plan was better than mine." Which GC would apply?
- A.
GC1612, because the caller missed open enrollment.
- B.
GC1610, it is an error because the member forgot to call us.
- C.
None, GC1612 is only used when there is a loss of Medicaid during open enrollment.
- D.
GC5, the member has moved out of the county.
- 22.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.
Tell the caller to fax the letter so it can be sent to AHCA for verification.
- B.
Tell the caller they have to wait until open enrollment to change.
- C.
Refer the caller to the health plan to request a new doctor.
- D.
Tell the caller to get an out of network authorization.
- 23.When the member has an issue with thier plan, what should they do first?
- A.
Immediately file a grievance.
- B.
Call the health plan first, they may be able to assist the member.
- C.
File a complaint with the Area Medicaid Office.
- D.
Call DCF to file a complaint.
- 24.One of the GC9 questions in HealthTrack asks: Was the member mandatorily assigned to the current plan? How do you determine this?
- A.
Ask the caller if they picked the plan or not.
- B.
Just answer "yes" to the question, so that the GC9 can be submitted.
- C.
Look in HealthTrack History or FMMIS.
- D.
Look at previous call notes, if the previous agent answered "yes", then do the same.
- 25.Where should you refer LTC recipients who need additional assistance with changing from a PACE plan?
- A.
Local Area Office
- B.
Elder Helpline
- C.
CARES
- D.
DCF
.png "Why is the recipient listed below Excluded from enrolling into a LTC plan?")
.png "Why is the recipient below categorized as Voluntary?")
.png "The recipient calls to enroll into a plan. The agent informs the recipient they are not eligible to enroll into a LTC plan because they receive services through the Agency for Persons with Disabilites waiver .")
.png "The recipient's mother calls in to enroll her son into a plan. Is the recipient eligible to enroll into a managed care plan?")
.PNG "When did the member's current Medicaid HMO start?")
.JPG "When did the member's most recent Medicaid start?")
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