Membersupport : MLTC Quiz 1
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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?
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Letters & Attachments
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Member Contacts
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Member File
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Authorizations
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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.
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- 2.
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
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Social Work dept.
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Field Assessor
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Care Coordinator
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Care Manager
Correct Answer
A. Care ManagerExplanation
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.Rate this question:
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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?
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Customer care - general inbound
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Sw inquiry
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Customer care - care manager services
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Customer care- sw inquiry
Correct Answer
A. Customer care - care manager servicesExplanation
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.Rate this question:
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- 4.
Prospect Calls to Reschedule UAS Assessment. Where in Casetrakker can an MSR confirm there is an already scheduled UAS assessment?
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JOURNAL & MEMBER FILE
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JOURNAL & AUTHORIZATIONS
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JOURNAL & MEMBER CONTACTS
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JOURNAL & LETTERS & ATTACHMENTS
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JOURNAL & ASSESSMENTS
Correct Answer
A. JOURNAL & MEMBER CONTACTSExplanation
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.Rate this question:
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- 5.
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 ________
Correct Answer
care manager, the care manager, cm, the cm, Cm, CM, The Care Manager, The care manager, The Cm, THE CM, Care ManagerExplanation
The correct answer is "care manager". This is because Ms Lopez is requesting her aide to come back tomorrow, so the email should be sent to the person responsible for managing the care, which is the care manager. The various capitalizations and word order variations in the answer options do not affect the meaning and can be used interchangeably.Rate this question:
- 6.
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 :
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Cm
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Um
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Enrollment
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Field assessor
Correct Answer
A. UmExplanation
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.Rate this question:
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- 7.
Members Daughter Calls & Request Services for A Family Member to Take Care of Her Mom.Who should MSR send an email to :
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Care Manager
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Social Work dept.
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Intake UAS Nurse
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Intake CDPAP
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Intake Coordinator
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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.Rate this question:
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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
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True
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False
Correct Answer
A. FalseExplanation
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.Rate this question:
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- 9.
MBRS DAUGHTER IS REQUESTING A CM CHANGE. SHE IS REQUESTING A SPANISH SPEAKING CM FOR BETTER COMMUNICATION. WHO SHOULD AN MSR CONTACT
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MEMBER SERVICES SUPERVISOR
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CLINICAL TEAM MANAGER
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CARE MANAGER
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CARE COORDINATOR
Correct Answer
A. CLINICAL TEAM MANAGERExplanation
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.Rate this question:
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Current Version
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Mar 20, 2023Quiz Edited by
ProProfs Editorial Team -
Oct 08, 2017Quiz Created by
Jessikerrabbit
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