Discrepancy Log And Dar Refresher Quiz
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- 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.
Correct Answer
B. Refer the caller to DCF regarding the Medicaid Application status.Explanation
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.Rate this question:
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- 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
Correct Answer
C. HomeSafeNetExplanation
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.Rate this question:
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- 3.
What does the DAR stand for?
- A.
Direct Authorized Representative
- B.
Designated Automatic Representative
- C.
Designated Authorized Representative
- D.
Demonstrative Agency Reporting
Correct Answer
C. Designated Authorized RepresentativeExplanation
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.Rate this question:
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- 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.
Correct Answer
D. Refer the member to CMS regarding updating the CMS eligibility.Explanation
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.Rate this question:
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- 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.
Correct Answer
D. Submit a MC EX/SC request in HT.Explanation
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.Rate this question:
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- 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.
Correct Answer
C. Use the arrow to convert the MMA current enrollment to a voluntary choice. -
- 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.
Correct Answer
D. Do not process any changes, advise the member to call back within 24-48 hours.Explanation
Based on the information provided, the correct answer is to not process any changes and advise the member to call back within 24-48 hours. This is because FLMMIS, which is a reliable source, shows that the member resides in Sarasota County. However, HealthTrack, which may not be as accurate, shows that the member lives in Leon County. Since there was an update in FLMMIS recently, it is possible that the system has not yet updated in HealthTrack. Therefore, it is best to wait for 24-48 hours to allow the system to synchronize and then proceed with the necessary changes.Rate this question:
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- 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.
Correct Answer
A. Advise the caller to fax in the Special Condition documentation.Explanation
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.Rate this question:
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- 9.
A DAR form should be submitted when a 43 year old male calls for his 42 year old wife.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
A DAR form should be submitted when a 43 year old male calls for his 42 year old wife because a DAR form, which stands for Demographic, Account, and Reason for Call, is typically used to collect important information about the caller and the reason for the call. In this case, it is necessary to gather demographic information about both the caller (the 43 year old male) and the person being called (the 42 year old wife). This information can help in documenting and tracking the call appropriately.Rate this question:
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- 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.
Correct Answer
A. Inform the mother that she must send in a signed copy of the Designated Authorized Representative form and continue the call.Explanation
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.Rate this question:
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- 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.
Correct Answer
C. When there is a discrepancy between HT and FLMMIS.Explanation
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.Rate this question:
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- 12.
To update Level of Care, the member should be referred to DCF.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 13.
Special Conditions are always active for only 1 year.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 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.
Correct Answer
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
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 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.
Correct Answer
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.Explanation
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.Rate this question:
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- 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.
Correct Answer
B. Select the MC EX/SC Request button in HealthTrack and document the request.Explanation
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.Rate this question:
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- 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
Correct Answer
D. DOEA and DCFExplanation
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.Rate this question:
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- 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
Correct Answer
A. DOEAExplanation
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).Rate this question:
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- 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.
Correct Answer
A. Advise the member to fax in Special Condition documentation. -
- 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.
Correct Answer
C. Refer the caller to DCF to update the HomeSafeNet Span.Explanation
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.Rate this question:
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- 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.
Correct Answer
C. Provide all plan options listed in HT wizard and refer the caller to Freedom to have the condition added.Explanation
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.Rate this question:
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.PNG "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?")
.PNG "Erika calls to verify her 19 year old son’s eligibility. How do you proceed?")
.PNG "The MMA recipient is interested in receiving LTC services, where do you refer them?")
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