Membersupport : MLTC Quiz 1

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| By Jessikerrabbit
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Jessikerrabbit
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Quizzes Created: 1 | Total Attempts: 75
| Attempts: 75
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  • 1/10 Questions

    Ms Lopez  calls to inform she is back from vacation and would like her aide to come back tommorow. MSR should send an email to ________

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About This Quiz

This quiz titled 'MEMBERSUPPORT: MLTC QUIZ 1' assesses skills in navigating Casetrakker for managing healthcare services and authorizations. It tests knowledge on handling real-world scenarios such as claim denials, member service requests, and coordination with care managers.

Membersupport : MLTC Quiz 1 - Quiz

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  • 2. 

    Provider calls to inquire on the reason for a denied claim. Which Tab in Casetrakker can you confirm if the provider was authorized to provide the denied service?

    • Letters & Attachments

    • Member Contacts

    • Member File

    • Authorizations

    Correct Answer
    A. Authorizations
    Explanation
    In order to confirm if the provider was authorized to provide the denied service, you would need to check the "Authorizations" tab in Casetrakker. This tab would contain information regarding any authorizations or approvals given to the provider for the specific service in question. By reviewing the details in the Authorizations tab, you can determine if the provider had the necessary authorization to provide the service that was denied.

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  • 3. 

    Members granddaughter Jane Doe, called requesting additional hha hours for member; as members health condition has changed. Jane is requesting member receive 5 days/ 8 hours each day as member is in the hospital due to a stroke and will be returning home soon. What is the activity detail in CaseTrakker?

    • Customer care - general inbound

    • Sw inquiry

    • Customer care - care manager services

    • Customer care- sw inquiry

    Correct Answer
    A. Customer care - care manager services
    Explanation
    The correct answer is "customer care - care manager services" because Jane Doe is requesting additional home health aide (hha) hours for the member due to a change in their health condition. This falls under the responsibility of care managers who handle and coordinate the care services for members.

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  • 4. 

    Members granddaughter Janice called requesting additional hha hours for member; as members health condition has changed. Jane is requesting member receive 5 days/ 8 hours each day as member is in the hospital due to a stroke and will be returning home soon. MSR will call or send an email to the 

    • Social Work dept.

    • Field Assessor

    • Care Coordinator

    • Care Manager

    Correct Answer
    A. Care Manager
    Explanation
    The correct answer is Care Manager. The Care Manager is responsible for coordinating and managing the care of the member, especially when there are changes in their health condition. In this case, the member's granddaughter is requesting additional home health aide hours for the member who is in the hospital due to a stroke. The Care Manager would be the appropriate person to contact in order to arrange for the additional hours and ensure that the member's needs are met.

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  • 5. 

    Provider calls because they received an authorization to provide Home Care services on 10/15/17 for 20 hours a week but the plan of care is 22 hours a week. MSR should contact :

    • Cm

    • Um

    • Enrollment

    • Field assessor

    Correct Answer
    A. Um
    Explanation
    The correct answer is "um". UM stands for Utilization Management, which is responsible for reviewing and approving the plan of care. In this scenario, the provider received authorization for 20 hours a week, but the plan of care is for 22 hours a week. Therefore, the UM department should be contacted to review and approve the additional 2 hours of care.

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  • 6. 

    Members Daughter Calls & Request Services for A Family Member to Take Care of Her Mom.Who should MSR send an email to :

    • Care Manager

    • Social Work dept.

    • Intake UAS Nurse

    • Intake CDPAP

    • Intake Coordinator

    • CDPAP dept.

    Correct Answer
    A. CDPAP dept.
    Explanation
    MSR should send an email to the CDPAP department because the member's daughter is requesting services for a family member to take care of her mom. CDPAP (Consumer Directed Personal Assistance Program) is a program that allows individuals to hire and manage their own caregivers, so it would be the appropriate department to handle this request.

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  • 7. 

    MBRS DAUGHTER IS REQUESTING A CM CHANGE. SHE IS REQUESTING A SPANISH SPEAKING CM FOR BETTER COMMUNICATION. WHO SHOULD AN MSR CONTACT

    • MEMBER SERVICES SUPERVISOR

    • CLINICAL TEAM MANAGER

    • CARE MANAGER

    • CARE COORDINATOR

    Correct Answer
    A. CLINICAL TEAM MANAGER
    Explanation
    The correct answer is the Clinical Team Manager because the member's daughter is requesting a change in the care manager (CM) for better communication, specifically a Spanish-speaking CM. The Clinical Team Manager is responsible for overseeing the care management team, including assigning CMs to members. Therefore, the MSR should contact the Clinical Team Manager to address the request and assign a Spanish-speaking CM to the member.

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  • 8. 

    MBRS DAUGHTER CALLED TO ADVISE MBR WILL BE ENROLLED INTO CpHL IN 2 WEEKS BUT RECEIVED A LETTER ADVISING MBR WILL BE ASSIGNED TO CARING HOME CARE. MBR WISHES TO STAY WITH SAME AGENCY SHE HAS NOW, WHITE GLOVE. MSR SHOULD CONTACT THE CARE MANAGER

    • True

    • False

    Correct Answer
    A. False
    Explanation
    The answer is false because the statement in the question does not provide any information about whether or not the daughter actually called the care manager. Therefore, it cannot be determined whether or not the MSR should contact the care manager.

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  • 9. 

    Prospect Calls to Reschedule UAS Assessment. Where in Casetrakker can an MSR confirm there is an already scheduled UAS assessment?

    • JOURNAL & MEMBER FILE

    • JOURNAL & AUTHORIZATIONS

    • JOURNAL & MEMBER CONTACTS

    • JOURNAL & LETTERS & ATTACHMENTS

    • JOURNAL & ASSESSMENTS

    Correct Answer
    A. JOURNAL & MEMBER CONTACTS
    Explanation
    In Casetrakker, an MSR can confirm that there is an already scheduled UAS assessment by checking the "JOURNAL & MEMBER CONTACTS" section. This section would contain all the relevant information and records of any communication or contact made with the prospect regarding the rescheduling of the UAS assessment.

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Quiz Review Timeline (Updated): Mar 20, 2023 +

Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 20, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Oct 08, 2017
    Quiz Created by
    Jessikerrabbit

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