Discrepancy Log And Dar Refresher Quiz

The correct answer is to select the MC EX/SC Request button in HealthTrack and document the request. This option is the most appropriate because it directly addresses the issue at hand and provides a clear and efficient way to request the removal of the special conditions. Contacting SNU or filing a complaint may not be necessary or effective in this situation. Submitting a task to a supervisor may be an option, but it does not specify how to request the removal of the conditions.

The correct answer is to submit a MC EX/SC request in HT. This is the appropriate course of action because Joe Smith wants the special condition of being auto-assigned to Clear Health Alliance removed. By submitting a MC EX/SC request in HT, the request will be processed and the necessary steps will be taken to remove the special condition from Joe's account.

The correct answer is to refer the caller to DCF (Department of Children and Families) to update the HomeSafeNet Span. Since HomeSafeNet is not listed under the Special Conditions in HealthTrack or FLMMIS, it implies that the system needs to be updated with this information. DCF is responsible for managing and updating the child welfare system, so they should be contacted to add HomeSafeNet to the system.

The answer is B, "False." A DAR form is used when there is a possible instance of abuse, neglect, or exploitation. The example provided in the question does not suggest any of these circumstances.

A 42-year-old woman is an adult and is capable of making her own decisions. While the age difference between the husband and wife may raise eyebrows for some, it does not necessarily indicate any cause for concern or the need to submit a DAR form.

The correct answer is DOEA and DCF. When an MMA recipient is interested in receiving Long-Term Care (LTC) services, they can be referred to the Department of Elder Affairs (DOEA) and the Department of Children and Families (DCF). These two agencies are responsible for providing and coordinating LTC services for eligible individuals. They can provide information, assess eligibility, and help the recipient access the appropriate services and resources for their specific needs.

The correct answer suggests that the caller should be provided with all the plan options listed in the HT wizard and then referred to Freedom to have their condition added. This implies that Freedom Health Specialty plan does cover COPD, and by referring the caller to Freedom, they can proceed with enrolling into the plan that covers their condition.

The correct answer is to inform the mother that she must send in a signed copy of the Designated Authorized Representative form and continue the call. This is because the son's eligibility needs to be verified, and the mother can act as a representative on his behalf by submitting the required form. By doing so, the mother will be authorized to speak and proceed with the call.

The correct answer is DOEA. DOEA stands for Department of Elder Affairs, which is the agency that provides assistance and support to elderly individuals in Florida. In this scenario, the member is calling to enroll into a Long-Term Care (LTC) plan, and the agent notices that the level of care is missing from the member's information. To address this issue and provide the necessary assistance, the agent should refer the member to the Department of Elder Affairs (DOEA).

The correct answer is B, "The agent must submit a MC EX/SC request in HealthTrack."

Since the member has been diagnosed with HIV, which is a special condition that needs to be recorded in the HealthTrack system, the agent must take action to ensure the member's health plan can accommodate their condition.

By submitting a MC EX/SC (Member Characteristics Exception/Special Condition) request in HealthTrack, the agent is formally notifying the appropriate parties that the member has a special condition that requires special coverage. This will ensure that the member receives the appropriate care and coverage for their HIV diagnosis.

The correct answer is when there is a discrepancy between HT and FLMMIS. This means that if there is a difference or inconsistency between the information in HT (presumably a system or database) and FLMMIS (another system or database), a request should be placed on the Discrepancy Log to address and resolve the issue. The other options provided in the question are not valid reasons for placing a request on the Discrepancy Log.

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The statement suggests that in order to update the Level of Care, the member should be referred to DCF. However, the correct answer is False. This means that referring the member to DCF is not necessary to update the Level of Care. There may be other processes or procedures in place to update the Level of Care without involving DCF.

Special Conditions are not always active for only 1 year. The duration of Special Conditions can vary depending on the specific circumstances and terms of the condition. It could be active for a shorter or longer period of time, depending on the agreement or situation in question. Therefore, the statement is false.

The correct answer is C, "Place the enrollment request on the Discrepancy Log."

Since the member's eligibility has been updated but HealthTrack has not yet reflected the change, the appropriate action is to place the enrollment request on the Discrepancy Log.

A Discrepancy Log is a document used to record inconsistencies or errors in the system, and in this case, it would serve as a record of the discrepancy between the member's actual eligibility and what is showing in the HealthTrack system.

The correct answer is HomeSafeNet. HomeSafeNet is a special condition span that needs to be on file in order to enroll a child into the Sunshine Health Child Welfare plan. This condition ensures that the child's safety and well-being are monitored and protected while in state custody.

If Jane Smith called to enroll into the LTC plan American ElderCare but there is no Medicaid Application on file, the appropriate course of action would be to refer the caller to DCF (Department of Children and Families) regarding the Medicaid Application status. DCF would be the appropriate agency to handle and provide information on the status of the Medicaid Application.

The correct answer is C, "Place the request on the discrepancy log."

Since the member's address information is inconsistent between HealthTrack and FLMMIS (Florida Medicaid Management Information System), the appropriate action is to place the request on the discrepancy log. This will create a record of the inconsistency and ensure that the issue is resolved as soon as possible.

The discrepancy log will also help to document the steps taken to resolve the issue, including the date and time the inconsistency was discovered and the steps taken to verify and update the information in the system.

The given explanation states that the member is excluded from enrolling in a plan due to their incarceration span. Although the member claims to have been released early, the FLMMIS system still shows them as currently incarcerated. Therefore, the member cannot enroll in a plan during the call. Hence, the correct answer is False.

The DAR stands for Designated Authorized Representative. This term refers to an individual or entity that has been given the authority to act on behalf of another person or organization in a specific capacity. The Designated Authorized Representative is responsible for representing and making decisions on behalf of the person or organization they are designated to represent.

The correct answer is to advise the caller to fax in the Special Condition documentation. This is the appropriate step to enroll a member into a SMI or HIV/AIDS Specialty Plan. The other options, such as placing the request on the discrepancy log or filing a complaint, are not relevant to the enrollment process. Additionally, advising the caller to fax in documentation and submit a MC EX/SC Request all in the same call is not mentioned as a requirement for enrollment. Therefore, the correct course of action is to advise the caller to fax in the necessary documentation.

The correct answer is to refer the member to CMS regarding updating the CMS eligibility. This is because FLMMIS shows that the member's CMS span ends on 3/31, indicating that their eligibility needs to be updated with CMS. The agent should not advise the parent to fax in documentation or inform them that the member can no longer enroll into CMS after 3/31. Additionally, asking the parent to call back in 24-48 hours may not be helpful as it is not clear if the system will update in that time frame.

The caller is not required to fax in another signed copy every time they call in. Once the document is faxed in, it will be added to HealthTrack and there is no need to send another copy. However, if the document has an expiration date that has expired, then the DAR must be faxed again. This ensures that the member will always have an updated DAR on file.