This quiz assesses knowledge pertinent to Medicaid plan changes, enrollment options, and handling insurance discrepancies. It is designed for Lead Choice Counseling Specialists to ensure compliance and effective communication in managed care environments.
08/01/2015
09/01/2015
10/01/2015
11/01/2015
Rate this question:
SSA
Area Office
Health Plan
DCF
Rate this question:
Area Office
DCF
The Insurance Company
TPL Corrections
Rate this question:
They are not eligible to make a plan change because they are currently in a Nursing Home.
Can change plan to PACE only.
Can change into another available LTC plan.
They must keep the current American Eldercare plan.
Rate this question:
Only FFS because they are voluntary.
Cannot enroll into a plan because of an active TPL on file.
The recipient is voluntary because of the TPL on file and they have the options of remaining FFS or enrolling into a Health plan.
Only enroll into a plan and can not have FFS because of the TPL on file.
Rate this question:
Recipient is receiving Medicaid from the Social Security Administration.
Recipient has APD: IC meaning they are currently incarcerated.
Medicaid ended on 5/1/2010.
Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.
Rate this question:
She has (LTCC) indicator next to her level of care.
She has APD: WL meaning she is on the Agency for Persons with Disabilities Waitlist.
She has ( MWA ) ACWM.
She has APD: WL meaning she is on the Weight Loss Waiver Program.
Rate this question:
Special Conditions
Level of Care
Waiver Program
Eligibility
Rate this question:
True
False
Rate this question:
The recipient's LTC coverage has been terminated and they are no longer receiving services.
The recipient experienced a temporary loss and must pay for services until coverage is reinstated.
The recipient has experienced a temporary loss and will continue services at no charge for 60 days.
The recipient is not eligible to be enrolled into a LTC plan
Rate this question:
Yes, this recipient must be enrolled into a managed care plan
No, only recipient 18 and over can enroll into a Managed Medical Assistance plan
No, this recipient has an exemption
No, this recipient's Medicaid coverage ended on 1/1/2006
90
30
180
60
Rate this question:
Tell the caller the appointment needs to be cancelled and and re-scheduled with the new plan.
Explain Continuity of Care and refer to the new plan for more information.
Tell the caller the previous plan will cover services for up to 60 days.
Tell the caller the appointment will not be covered because the provider is not part of the MMA plan.
Rate this question:
05/01/2014
01/01/2013
03/01/2014
04/01/2013
Rate this question:
Auto Assigned
Voluntary Choice
Rate this question:
12/1/2007
3/1/2009
5/1/2010
5/1/2009
Rate this question:
A
B
C
D
Rate this question:
GC1
GC8
GC1612
GC9
Rate this question:
GC17
GC4
GC9
GC5
Rate this question:
GC1612, because the caller missed open enrollment.
GC1610, it is an error because the member forgot to call us.
None, GC1612 is only used when there is a loss of Medicaid during open enrollment.
GC5, the member has moved out of the county.
Tell the caller to fax the letter so it can be sent to AHCA for verification.
Tell the caller they have to wait until open enrollment to change.
Refer the caller to the health plan to request a new doctor.
Tell the caller to get an out of network authorization.
Rate this question:
Immediately file a grievance.
Call the health plan first, they may be able to assist the member.
File a complaint with the Area Medicaid Office.
Call DCF to file a complaint.
Rate this question:
Ask the caller if they picked the plan or not.
Just answer "yes" to the question, so that the GC9 can be submitted.
Look in HealthTrack History or FMMIS.
Look at previous call notes, if the previous agent answered "yes", then do the same.
Rate this question:
Local Area Office
Elder Helpline
CARES
DCF
Rate this question:
Through PACE because PACE covers medical and LTC services.
Through straight medicaid/FFS.
Through a MMA plan.
Through a LTC plan.
Rate this question:
Be responsible to pay for services while experiencing a temporary loss of Medicaid.
Be disenrolled from their Long Term Care plan.
Continue recieving services from the LTC plan for up to 60 days.
None of the above
Rate this question:
90 days will start as soon as the plan starts.
90 days will start on the first month eligibility has been received.
LTC recipients do not get 90 days to try out the plan.
90 days will start after open enrolllment.
Rate this question:
Tell the caller their doctor must update their medical record and report it to AHCA.
Tell the caller to fax us documentation of the special condition, so the case can be updated.
Tell the caller they must report their special condition to the Center's for Disease Control and the Department of Health.
Tell the caller the SNU Nurse will call them to get more information on their special condition and set up a home visit.
Rate this question:
Member can enroll in any plan except PACE.
Member can only enroll in an HMO.
Member can enroll in any plan including PACE.
Member can only enroll in PACE.
Rate this question:
Complete the plan change online.
Call SSA.
Call the Elder Helpline.
Call the SMMC line to request a plan change.
Rate this question:
The member has a PACE exemption.
The member is receiving medical services through a private insurance.
PACE provides medical services as well as LTC services.
Rate this question:
The managed care plan cannot deny or delay services based on their Medicaid eligibilty status.
The recipient can choose a plan but will not start services until Medicaid has been approved.
Services will start prior to Medicaid being approved.
None of the Above
Rate this question:
Change to another LTC plan.
Inform the recipient they are not eligible to make a plan change because they are eligible for a PACE.
Remain in United or disenroll from United and wait to receive services once Medicaid is approved.
Refer the recipient to DOEA to get an exemption because LTC recipients do not make plan changes without exemptions.
Rate this question:
Cannot change the plan while in Med Pending.
May be billed for services if Medicaid is denied.
May disenroll.
All of the above.
Rate this question:
Then the CMS questions will not have to be asked.
Then they will have to contact CMS directly to enroll.
Then the CMS questions have to be asked.
Then they cannot enroll into CMS.
Rate this question:
Then the child will have 60 days to continue to recieve services from CMS.
Then the child has been cured of the special condition.
Then the child can enroll into CMS.
Then the child will be disenrolled from CMS.
Rate this question:
Quiz Review Timeline (Updated): Mar 14, 2023 +
Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.
Wait!
Here's an interesting quiz for you.