Discrepancy Log And Dar Refresher Quiz

22 Questions | Total Attempts: 658

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Discrepancy Log And Dar Refresher Quiz - Quiz

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Questions and Answers
  • 1. 
    Jane Smith called to enroll into the LTC plan American ElderCare , but there was not a Medicaid Application on file. How would you proceed?
    • A. 

      Place the request on the discrepancy log.

    • B. 

      Refer the caller to DCF regarding the Medicaid Application status.

    • C. 

      File a complaint.

    • D. 

      Refer the member to DOEA regarding their LTC status.

  • 2. 
    The child has been placed into state custody and needs to be enrolled into Sunshine Health Child Welfare plan. Which special condition span needs to be on file in order to enroll into this specialty plan.
    • A. 

      CMS

    • B. 

      SMI

    • C. 

      HomeSafeNet

    • D. 

      HIV/AIDS

  • 3. 
    What does the DAR stand for?
    • A. 

      Direct Authorized Representative

    • B. 

      Designated Automatic Representative

    • C. 

      Designated Authorized Representative

    • D. 

      Demonstrative Agency Reporting

  • 4. 
    FLMMIS shows that the member's CMS span ends on 3/31. How should the agent proceed?
    • A. 

      Advised the parent to fax in documentation of the special condition.

    • B. 

      Inform the parent that the member can no longer enroll into CMS after 3/31/2015.

    • C. 

      Inform the parent to call back in 24-48 hours to see if the system updates.

    • D. 

      Refer the member to CMS regarding updating the CMS eligibility.

  • 5. 
    Joe Smith calls in and says he received a letter stating that he will be auto-assigned to Clear Health Alliance. Joe states he does not have AIDS and wants the special condition removed. How do you proceed?
    • A. 

      Place the request on the discrepancy log.

    • B. 

      Refer the caller to DCF.

    • C. 

      Advise the member to send in documentation stating he does not have HIV/AIDS.

    • D. 

      Submit a MC EX/SC request in HT.

  • 6. 
    Member is enrolled into Prestige and has an auto assignment into Magellan Complete Care. The member states they want to remain in Prestige. How should you proceed?
    • A. 

      Place on the Discrepancy Log.

    • B. 

      Escalate the call to Marsha/Lisa.

    • C. 

      Use the arrow to convert the MMA current enrollment to a voluntary choice.

    • D. 

      Inform the member that they will remain in Prestige.

  • 7. 
    Member calls on April 6th to change plans because they recently moved to Sarasota County.  HealthTrack is showing the member lives in Leon county. FLMMIS shows the member resides in Sarasota County. There was an update in FLMMIS on 04/04/2015, how should you proceed?
    • A. 

      Create a supervisor task.

    • B. 

      Refer the caller to DCF/ SSA.

    • C. 

      Place the request on the discrepancy log.

    • D. 

      Do not process any changes, advise the member to call back within 24-48 hours.

  • 8. 
    To enroll a member into a SMI or HIV/AIDS Specialty Plan, you must:
    • A. 

      Advise the caller to fax in the Special Condition documentation.

    • B. 

      Place the request on the discrepancy log.

    • C. 

      File a complaint .

    • D. 

      Advise the caller to fax in documentation and submit a MC EX/SC Request all in the same call.

  • 9. 
    A DAR form should be submitted when a 43 year old male calls for his 42 year old wife.
    • A. 

      True

    • B. 

      False

  • 10. 
    Erika calls to verify her 19 year old son’s eligibility. How do you proceed?
    • A. 

      Inform the mother that she must send in a signed copy of the Designated Authorized Representative form and continue the call.

    • B. 

      Verify the address, member's name, and DOB. If mom passes verification, continue with the call.

    • C. 

      Inform the mom that her son must call in and authorize her to speak on his behalf.

    • D. 

      Do not continue with the call because mom is not the legal guardian/power of attorney.

  • 11. 
    When do you place a request on the Discrepancy Log?
    • A. 

      When the caller is screaming at you and to hurry and get them off your phone.

    • B. 

      When it’s almost your break or lunch time and/or near the end of your shift and you want to keep your adherence up.

    • C. 

      When there is a discrepancy between HT and FLMMIS.

    • D. 

      When HT is down and not working.

  • 12. 
    To update Level of Care, the member should be referred to DCF.
    • A. 

      True

    • B. 

      False

  • 13. 
    Special Conditions are always active for only 1 year.
    • A. 

      True

    • B. 

      False

  • 14. 
    Member’s eligibility was updated on Saturday, February 9th, reflecting active coverage. HealthTrack still shows the member as not eligible on Monday, February 11th. How do you proceed?
    • A. 

      Advised the member they are not covered under Medicaid.

    • B. 

      Refer the member to DCF.

    • C. 

      Place the enrollment request on the Discrepancy Log.

    • D. 

      Advise the member to call back in 24-48 business hours to allow HealthTrack time to update.

  • 15. 
    Member is excluded because of an incarceration span. The member calls in and states they were released early. FLMMIS reflects the member is still currently incarcerated. Since the member told us they were released, they are able to enroll into a plan during the call.
    • A. 

      True

    • B. 

      False

  • 16. 
    If the caller has a DAR on file, are they still required to fax in another signed copy every time they call in?
    • A. 

      Yes. The caller is required to agree to fax in documentation on every call.

    • B. 

      No. The caller is only required to have one DAR on file. This DAR will apply for any member the caller calls in for.

    • C. 

      No. Once faxed in, the document will be added to HealthTrack and the caller does not need to fax in another copy. If the document has an expiration date that has expired, then the DAR must be faxed again.

    • D. 

      Yes. This ensures the member will always have an updated DAR on file.

  • 17. 
    To remove  HIV/AIDS, SMI, or Freedom special conditions from a recipients case, the agent should:
    • A. 

      Contact SNU and the request they remove the condition.

    • B. 

      Select the MC EX/SC Request button in HealthTrack and document the request.

    • C. 

      Submit a task to a supervisor and request the removal.

    • D. 

      File a complaint in the complaint wizard.

  • 18. 
    The MMA recipient is interested in receiving LTC services, where do you refer them?
    • A. 

      SSA and Medicare

    • B. 

      AHCA Medicaid Helpline

    • C. 

      SSA

    • D. 

      DOEA and DCF

  • 19. 
    Member calls in to enroll into a LTC plan. Agent hovers over the member’s information and notices that the level of care is missing. Where should you refer the member for assistance?
    • A. 

      DOEA

    • B. 

      SSA

    • C. 

      Supervisor Line

    • D. 

      DCF

  • 20. 
    Member calls in and states, “I was just diagnosed with HIV and need to change to a plan that will cater to my condition”. Agent doesn’t see the special condition on file. How should you proceed?
    • A. 

      Advise the member to fax in Special Condition documentation.

    • B. 

      The agent must submit a MC EX/SC request in HealthTrack.

    • C. 

      Refer the caller to DCF.

    • D. 

      Advise the caller to have their doctor contact the specialty plan.

  • 21. 
    A foster parent calls in and says the child she has is under state care and needs to be enrolled into Sunshine Health Child Welfare Plan. HomeSafeNet is not listed under the Special Conditions in HealthTrack or FLMMIS. How should you proceed?
    • A. 

      Inform the foster parent that Sunshine Health Child Welfare Plan is not an enrollment option.

    • B. 

      Advise the caller to set up a court session with the local judge to get documentation added to the system.

    • C. 

      Refer the caller to DCF to update the HomeSafeNet Span.

    • D. 

      Advised the caller to fax in legal documentation to (850) 402-4679.

  • 22. 
    A member calls in and says they have COPD and want to enroll into Freedom Health Specialty plan. Freedom is not an option in HT. How should you proceed?
    • A. 

      Advise the caller that COPD is covered under all MMA plans.

    • B. 

      Place the request on the discrepancy log for a manual enrollment.

    • C. 

      Provide all plan options listed in HT wizard and refer the caller to Freedom to have the condition added.

    • D. 

      Refer the caller to DCF to have the information documented in the state system.

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