11.19 Abbreviated Smmc & Dental Final

25 Questions | Total Attempts: 82

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11.19 Abbreviated Smmc & Dental Final - Quiz

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Questions and Answers
  • 1. 
    The caller is enrolled in a MMA plan and wants to know if acupuncture is covered by the plan.  How do you proceed?
    • A. 

      Refer to SSA

    • B. 

      Refer to DCF

    • C. 

      Refer to the MMA plan

    • D. 

      Refer to AHCA

  • 2. 
    The caller needs a list of providers that accept FFS/straight Medicaid. How do you proceed?
    • A. 

      Refer to DOEA

    • B. 

      Refer to AHCA

    • C. 

      Refer to SSA

    • D. 

      Refer to the MMA plan

  • 3. 
    Recipients that are REQUIRED to enroll in a managed care plan are
    • A. 

      Voluntary

    • B. 

      Not Eligible

    • C. 

      Excluded

    • D. 

      Mandatory

  • 4. 
    Which dental benefit below is NOT available for Medicaid recipients over 21?
    • A. 

      Dental Exams

    • B. 

      Teeth Cleanings

    • C. 

      Sedations

    • D. 

      Extractions

  • 5. 
    Which are the special conditions required to enroll in a specialty plan?
    • A. 

      Children with chronic conditions, children in child welfare, individuals with HIV/AIDS, and individuals with serious mental illness

    • B. 

      Children with chronic conditions, adults with seizures, adults with heart problems, and individuals with serious mental illness

    • C. 

      Children that were premature, adults with depression, adults with diabetes, and individuals with brain trauma

    • D. 

      Children with chronic conditions, adults with asthma, adults with HIV/AIDS, and individuals with serious mental illness

  • 6. 
    If the caller does not have a dentist, you should:
    • A. 

      Offer to search for a dentist in the area, ask for preferences such as male or female, a language preference, etc.

    • B. 

      Tell the caller to research the dentists in the area and call us back

    • C. 

      Tell the caller the plan will send a list of dentists when the plan becomes effective

    • D. 

      Provide the caller the plan website so they can get a full list of dentists

  • 7. 
    An enrollee asks, “When will the dental plan send my card?” What should you inform the enrollee?
    • A. 

      Inform the enrollee that they will receive the dental card prior to when their enrollment begins

    • B. 

      Advise the enrollee that the dental card should come after the effective date

    • C. 

      Inform the enrollee that they should receive the dental card within 5-7 business days

    • D. 

      Refer the enrollee to the AHCA Medicaid Helpline to ask when the dental card will be sent

  • 8. 
    When a recipient has an "A" or "N" in HT for MMA and Dental, you should...
    • A. 

      Refer the caller to DCF/SSA because they are not eligible yet

    • B. 

      Do not ask questions and automatically transfer to extension 2042

    • C. 

      Transfer to Express Enrollment

    • D. 

      Advise the recipient to allow 24-48 business hours for their eligibility to update and call back

  • 9. 
    Which specialty plan will this enrollee be auto-assigned to first?
    • A. 

      Staywell

    • B. 

      Children’s Medical Services

    • C. 

      Sunshine Health

    • D. 

      Clear Health Alliance

  • 10. 
    What plan types will this recipient be able to enroll into?
    • A. 

      MMA-only plans, the LTC+ Plan, Comprehensive Plans and Dental Plans

    • B. 

      Only the LTC+ Plan and Dental Plans

    • C. 

      The LTC+ Plan, Comprehensive Plans and Dental Plans

    • D. 

      All SMMC and Dental plans will be available to the recipient

  • 11. 
    If the dentist does not populate in HealthTrack, how should the agent proceed?
    • A. 

      Inform the caller that their dentist does not participate with the SMMC plans and a new dentist will be auto-assigned by the plan

    • B. 

      Advise the caller to contact the plan after it becomes effective to add the dentist to the enrollment

    • C. 

      Tell the caller that they will need to choose a new dentist and ask for their preferences to search for a different dentist in HealthTrack

    • D. 

      Refer the caller to the AHCA Medicaid Helpline to get a list of dental providers

  • 12. 
    Which are examples of expanded benefits?
    • A. 

      Prescriptions, Check Ups, Laboratory, X Rays, Plastic Surgery

    • B. 

      Over the Counter Benefit, Vision Services, Waived Copayments

    • C. 

      Surgery, Birthing Center Services, Hospice Services

    • D. 

      Emergency Services, Transportation, Podiatric Services, Aromatherapy

  • 13. 
    When a recipient has an "A" for LTC, you should...
    • A. 

      Refer the caller to DCF/SSA because they are not eligible yet

    • B. 

      Process the enrollment as a pending choice for the LTC plan and inform the caller that the plan will become effective when the eligibility is approved

    • C. 

      Transfer to Express Enrollment

    • D. 

      Advise the recipient to allow 24-48 business hours for their eligibility to update and call back

  • 14. 
    Which of the following listed below is not a Prohibited Activity?
    • A. 

      Agent states: "Yes, this LTC+ plan will best meet all of your needs."

    • B. 

      Agent states: "My grandmother has that plan, you'd probably like it too."

    • C. 

      Agent states: " You'd get more services and better doctors with this plan."

    • D. 

      Agent states: "All SMMC and Dental plans offer dental services. If the information you need is not available on the brochure, contact the plan for more information."

  • 15. 
    For MMA, Enrollees whose Medicaid eligibility ends for less than 6 months (180 days) are in a ________________________ period. If Medicaid eligibility is regained, they will be reinstated back into the plan they had previously (if available).
    • A. 

      No change

    • B. 

      Open enrollment

    • C. 

      Reinstatement

    • D. 

      Lock-In

  • 16. 
    Can recipients who are eligible for both MMA and LTC enroll into a Specialty plan if they have an active Special Condition on file?
    • A. 

      No, Specialty Plans cannot provide LTC Services and will not be an option for LTC eligible recipients.

    • B. 

      Yes, as long as the Special Condition is active, Specialty Plans will be available to the recipient.

    • C. 

      Yes, Specialty Plans are available in all regions for all the Special Conditions.

    • D. 

      No, Specialty Plans are only available for recipients under the age of 21.

  • 17. 
    If a caller requests a PCP during the enrollment and after the first attempt you cannot find the PCP in the provider search you should...
    • A. 

      Ask the caller for more information and keep trying to find a PCP

    • B. 

      Advise the caller that the PCP wasn't found in the provider search because the doctor is not accepting the plan

    • C. 

      Advise the caller that the PCP was not found in our system. That doesn't mean that the doctor is not accepting the plan and she/he can contact the plan once is effective to add the PCP 

    • D. 

      Inform the caller That you cannot complete the enrollment without the PCP

  • 18. 
    This enrollee wants to know what plan they currently have. What can you inform them?
    • A. 

      Advise the enrollee that they are currently enrolled with Simply Healthcare for MMA and LTC services, Also enrolled with LIBERTY for the dental plan, and both plans were effective 12/01/2018

    • B. 

      Inform the enrollee they are not currently enrolled in a plan for MMA and LTC and need to choose a plan for dental since they don't have one

    • C. 

      Tell the enrollee that they are being disenrolled from Simply Healthcare, but you can assist them to enroll into one of the plans currently available in their area. Advise the enrollee that they will need to choose a dental plan, or they will be auto-assigned.

    • D. 

      Notify the enrollee that because there are new plans available through the new Statewide Medicaid Managed Care Program, they will be auto-assigned to both a new Health and Dental Plan.

  • 19. 
    This enrollee heard about the changes happening in their area and want to know what is happening in their case. Which option provides the best overview of the case?
    • A. 

      Inform the enrollee that due to the changes in the Statewide Medicaid Managed Care Program, they are being disenrolled from United Healthcare and enrolled back into the same plan effective 2/1/2019 since United Healthcare is available in the area under the New Program. MCNA Dental will be effective 2/1/2019 as well.

    • B. 

      Advise the enrollee that due to the changes in the Statewide Medicaid Managed Care Program, they are being disenrolled from United Healthcare and they will have to wait until 2/1/2019 to make a plan change.

    • C. 

      Tell the enrollee that due to the changes in the Statewide Medicaid Managed Care program, they are being disenrolled from United Healthcare and they should contact AHCA if they want to keep the plan. Advise they have an auto-assignment into MCNA and can choose their dental plan.

    • D. 

      Inform the enrollee that changes are being made to the Statewide Medicaid Managed Care program, and to call back after 2/1/2019 to get more information about what options are available.

  • 20. 
    Who can enroll in a Comprehensive Plan?
    • A. 

      MMA recipients, MMA recipients eligible for a specialty plan, and LTC recipients

    • B. 

      LTC and Medicare recipients only

    • C. 

      Everyone except recipients that qualify for a specialty plan

    • D. 

      MMA recipients eligible for a specialty plan and LTC recipients

  • 21. 
    The caller needs to know what plan their child has, and when reviewing the case, you see a "K" for the eligibility category and the child is enrolled in Sunshine Health. How do you proceed?
    • A. 

      Refer to Sunshine Health

    • B. 

      Refer to DCF

    • C. 

      Refer to the MediKids Helpline

    • D. 

      Refer to the AHCA Medicaid Helpline

  • 22. 
    Sonia Allen is new to Medicaid. She just enrolled into a plan for the first time and is worried that she may not like it. What can you tell her?
    • A. 

      "Since this is free medical care, once you enroll you cannot change it."

    • B. 

      "Don't worry, you have 60 days for open enrollment to change the plan for any reason, call us back if you want to change the plan."

    • C. 

      "Once you enroll, you will be in a no change period, and you will not be able to change the plan."

    • D. 

      "Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan."

  • 23. 
    A mother from Region 9 wants to know when circumcision is no longer available through Humana for her baby. What can you advise the caller?
    • A. 

      Since circumcision is available on the Expanded Benefits grid, there is no timeframe and she can have the circumcision performed at any time.

    • B. 

      The information for circumcision shows it is for newborns only, so if she does not have the procedure immediately after the baby is born, it will not be covered.

    • C. 

      Circumcisions are generally performed within the first 48 hours and up to three weeks after birth, so if it is past that timeframe, the service may not be covered.

    • D. 

      Advise the caller to contact the plan to get more information on the timeframe for when circumcisions are covered.

  • 24. 
    Which of the following plans is an option for enrollment?
    • A. 

      United Health Care of Florida

    • B. 

      Children's Medical Services

    • C. 

      Staywell

    • D. 

      Humana Medical Plan

  • 25. 
    A caller asks if their local Hospital, Florida Medical Center, accepts their plan Simply Healthcare. What can you inform the caller?
    • A. 

      Inform the caller Florida Medical Center will take all of the Medicaid plans.

    • B. 

      Inform the caller that Florida Medical Center accepts Simply HealthCare but only for recipients in Broward County.

    • C. 

      Inform the caller that Florida Medical Center accepts Simply HealthCare.

    • D. 

      Inform the caller Florida Medical Center does not accept Simply HealthCare.

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