Smmc: Healthtrack Member Information
.png "Smmc: Healthtrack Member Information - Quiz")
- 1.
What should you do if the HIV/AIDS special condition is not listed in the system?
- A.
Tell the caller their doctor must update their medical record and report it to AHCA.
- B.
Tell the caller to fax us documentation of the special condition, so the case can be updated.
- C.
Tell the caller they must report their special condition to the Center's for Disease Control and the Department of Health.
- D.
Tell the caller the SNU Nurse will call them to get more information on their special condition and set up a home visit.
Correct Answer
B. Tell the caller to fax us documentation of the special condition, so the case can be updated.Explanation
If the HIV/AIDS special condition is not listed in the system, the appropriate action would be to tell the caller to fax documentation of the special condition. This is necessary in order to update the case and ensure that the caller's medical record reflects their special condition.Rate this question:
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- 2.
If the recipient has an active CMS span on file,...
- A.
Then the CMS questions will not have to be asked.
- B.
Then they will have to contact CMS directly to enroll.
- C.
Then the CMS questions have to be asked.
- D.
Then they cannot enroll into CMS.
Correct Answer
A. Then the CMS questions will not have to be asked.Explanation
If the recipient has an active CMS span on file, then the CMS questions will not have to be asked. This means that if the recipient already has an active CMS span, which is a type of enrollment or authorization, there is no need to ask the CMS questions again. The CMS span on file indicates that the recipient's information and enrollment status have already been verified and recorded, so there is no need to repeat the process.Rate this question:
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- 3.
If a newly eligible child has an active CMS and HOMESAFENET span, which specialty plan will the member be auto-assigned to based on the specialty plan hierarchy?
- A.
Sunshine Health Child Welfare
- B.
Magellan Complete Care
- C.
Children's Medical Services
- D.
Positive Healthcare/Clear Health Alliance
Correct Answer
A. Sunshine Health Child WelfareExplanation
If a newly eligible child has an active CMS and HOMESAFENET span, they will be auto-assigned to the Sunshine Health Child Welfare specialty plan based on the specialty plan hierarchy.Rate this question:
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- 4.
The recipient calls in on 9/29/2017 and wants to make a plan change because their PCP doesn't accept their current plan. Can the recipient make a plan change?
- A.
No, they are currently in a no change period.
- B.
Yes, they qualify for a Good Cause plan change.
- C.
No, they are a mandatory member and must keep current plan.
- D.
Yes, they are currently in their 120 day change period.
Correct Answer
D. Yes, they are currently in their 120 day change period.Explanation
The recipient can make a plan change because they are currently in their 120 day change period. This means that they have the opportunity to switch plans within a specific time frame.Rate this question:
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- 5.
What options does this recipient have?
- A.
Change to another LTC plan.
- B.
Inform the recipient they are not eligible to make a plan change because they are eligible for PACE.
- C.
Remain in Sunshine Health or disenroll from Sunshine and wait to receive services once Medicaid is approved.
- D.
Refer the recipient to DOEA to get an exemption because LTC recipients do not make plan changes without exemptions.
Correct Answer
C. Remain in Sunshine Health or disenroll from Sunshine and wait to receive services once Medicaid is approved.Explanation
The recipient has the option to either remain in Sunshine Health or disenroll from Sunshine and wait to receive services once Medicaid is approved. This suggests that the recipient can choose to continue with their current plan or opt out and wait for Medicaid approval to receive services.Rate this question:
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- 6.
The recipient wants to change the direct service provider. How do you proceed?
- A.
Refer to DOEA.
- B.
Refer to the LTC plan.
- C.
Refer to AHCA.
- D.
Refer to the MMA plan.
Correct Answer
B. Refer to the LTC plan.Explanation
The correct answer is to refer to the LTC plan. This suggests that the recipient should consult the Long-Term Care (LTC) plan for guidance on changing their direct service provider. The LTC plan likely contains information and procedures regarding provider changes, ensuring that the recipient follows the appropriate steps to switch to a new service provider.Rate this question:
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- 7.
The recipient calls to make a LTC plan change. What are their options to receive services?
- A.
They are not eligible to make a plan change because they are currently in a Nursing Home.
- B.
Can change plan to PACE only.
- C.
Can change into another available LTC plan.
- D.
They must keep the current American Eldercare plan.
Correct Answer
B. Can change plan to PACE only.Explanation
The recipient is currently in a Nursing Home, which means they are not eligible to make a plan change. However, they do have the option to change their plan to PACE (Program of All-Inclusive Care for the Elderly) if they wish to receive services. They cannot change into another available LTC plan or keep the current American Eldercare plan.Rate this question:
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- 8.
By clicking on the icon below in HealthTrack what information is shown?
- A.
Pregnancy Information
- B.
Information for Children on the case
- C.
All of the previous case numbers for the member if they have switched cases.
- D.
CMS eligibility
Correct Answer
C. All of the previous case numbers for the member if they have switched cases.Explanation
By clicking on the icon below in HealthTrack, the information shown is all of the previous case numbers for the member if they have switched cases. This means that if the member has been assigned different case numbers in the past, this icon will display all of those previous case numbers.Rate this question:
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- 9.
The recipient calls to enroll into a managed care plan. What are their enrollment options?
- A.
Only FFS because they are voluntary.
- B.
Cannot enroll into a plan because of an active TPL on file.
- C.
The recipient is voluntary because of the TPL on file and they have the options of either remaining on FFS or enrolling into a health plan.
- D.
Only enroll into a plan and cannot have FFS because of the TPL on file.
Correct Answer
C. The recipient is voluntary because of the TPL on file and they have the options of either remaining on FFS or enrolling into a health plan.Explanation
The recipient has the option to either remain on Fee-for-Service (FFS) or enroll into a health plan. This is because the recipient is voluntary due to the Third Party Liability (TPL) on file. The TPL does not prevent the recipient from enrolling into a managed care plan, but rather gives them the choice to either stay on FFS or opt for a health plan.Rate this question:
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- 10.
The recipient calls to enroll into a plan. What is the best way to proceed?
- A.
Inform the recipient they cannot enroll into a plan because of the demise date of 12/15/2012 on file.
- B.
Inform the recipient they have APD and cannot enroll into a plan. Refer the recipient to DCF to have the demise date removed.
- C.
Inform the recipient they are dually eligible due to the APD and exemption and can only have FFS.
- D.
Inform the recipient they cannot enroll into a plan because there is an exemption on the case. Refer the recipient to DCF to have the date of demise removed.
Correct Answer
D. Inform the recipient they cannot enroll into a plan because there is an exemption on the case. Refer the recipient to DCF to have the date of demise removed.Explanation
The correct answer is to inform the recipient that they cannot enroll into a plan because there is an exemption on the case. The mention of the exemption indicates that there is a specific reason why the recipient cannot enroll, and it is necessary to refer them to DCF (Department of Children and Families) to have the date of demise removed. This suggests that there may be some incorrect or outdated information on file that needs to be corrected before the recipient can proceed with enrolling into a plan.Rate this question:
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- 11.
Why is the recipient listed below Excluded from enrolling into a LTC plan?
- A.
Recipient is receiving Medicaid from the Social Security Administration.
- B.
Recipient has APD: IC meaning they are currently incarcerated.
- C.
Medicaid ended on 5/1/2010.
- D.
Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.
Correct Answer
D. Recipient is currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.Explanation
The recipient is excluded from enrolling into a LTC (Long-Term Care) plan because they are currently living in an Intermediate Care Facility for Persons with Developmental Disabilities.Rate this question:
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- 12.
Why is the recipient below categorized as Voluntary?
- A.
She has (LTCC) indicator next to her level of care.
- B.
She has APD: WL meaning she is on the Agency for Persons with Disabilities Waitlist.
- C.
She has (MWA) ACWM.
- D.
She has APD: WL meaning she is on the Weight Loss Waiver Program.
Correct Answer
B. She has APD: WL meaning she is on the Agency for Persons with Disabilities Waitlist.Explanation
The recipient is categorized as Voluntary because she has APD: WL, which stands for Agency for Persons with Disabilities Waitlist. This indicates that she voluntarily applied to be on the waitlist for the Agency for Persons with Disabilities, suggesting that she is willingly seeking assistance or services from the agency.Rate this question:
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- 13.
What does the "T" shown for the recipient's LTC coverage mean ?
- A.
The recipient's LTC coverage has been terminated and they are no longer receiving services.
- B.
The recipient experienced a temporary loss and must pay for services until coverage is reinstated.
- C.
The recipient has experienced a temporary loss and will continue to receive services at no charge for 60 days.
- D.
The recipient is not eligible to be enrolled into a LTC plan.
Correct Answer
C. The recipient has experienced a temporary loss and will continue to receive services at no charge for 60 days.Explanation
The "T" shown for the recipient's LTC coverage means that the recipient has experienced a temporary loss and will continue to receive services at no charge for 60 days. This indicates that although their coverage has been temporarily interrupted, they will still be able to access LTC services without having to pay for them for a specified period of time.Rate this question:
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- 14.
The recipient's mother calls in to enroll her son into a plan. Is the recipient eligible to enroll into a managed care plan?
- A.
Yes, this recipient must be enrolled into a managed care plan.
- B.
No, only recipient 18 and over can enroll into a Managed Medical Assistance plan
- C.
No, this recipient has an exemption.
- D.
No, this recipient's Medicaid coverage ended on 1/1/2006.
Correct Answer
C. No, this recipient has an exemption.Explanation
The correct answer is "No, this recipient has an exemption." This means that the recipient is not eligible to enroll into a managed care plan because they have a specific exemption that prevents them from doing so. The reason for the exemption is not provided in the question.Rate this question:
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- 15.
When a member has an "A" or "N" in HT for MMA, 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.
Follow the script to determine if the member needs to be transferred to Express Enrollment.
- D.
Advise the member to allow 24-48 business hours for their eligibility to update and call back.
Correct Answer
C. Follow the script to determine if the member needs to be transferred to Express Enrollment.Explanation
If a member has an "A" or "N" in HT for MMA, the correct action is to follow the script to determine if the member needs to be transferred to Express Enrollment. This suggests that there is a specific protocol or set of questions in the script that helps determine whether the member should be transferred to Express Enrollment or not. By following the script, the agent can ensure that the appropriate action is taken based on the member's eligibility status.Rate this question:
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- 16.
This member needs to update their address, where should they call?
- A.
AHCA
- B.
DOEA
- C.
DCF
- D.
SSA
Correct Answer
D. SSAExplanation
The correct answer is SSA because the Social Security Administration (SSA) is responsible for maintaining and updating individuals' addresses in their records. Therefore, if a member needs to update their address, they should call the SSA.Rate this question:
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- 17.
Explain the coverage below:
- A.
The member will use FFS Medicaid to get services. Medicaid is primary and the private insurance is secondary.
- B.
The Member has QMB, it is not full Medicaid coverage. It covers Medicare premiums, deductibles and coinsurance. The member also has a Medicare Special Needs plan (TPL 11) that will cover services.
- C.
The member has Share of Cost. Medicaid will pay any service that is not covered by Medicare.
- D.
The member has a Special Needs Plan that will cover 80% of services and QMB will cover the other 20% for doctor's visits and prescriptions.
Correct Answer
B. The Member has QMB, it is not full Medicaid coverage. It covers Medicare premiums, deductibles and coinsurance. The member also has a Medicare Special Needs plan (TPL 11) that will cover services.Explanation
The member has QMB, which stands for Qualified Medicare Beneficiary, a program that provides assistance with Medicare premiums, deductibles, and coinsurance. This means that the member's Medicare costs are covered by QMB. Additionally, the member has a Medicare Special Needs Plan (TPL 11) that will cover services. This means that the member's medical services will be covered by this plan.Rate this question:
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- 18.
The caller needs to know the plan the child has, how do you proceed?
- A.
Refer to the plan
- B.
Assist the caller with what they need
- C.
Refer to the MediKids Helpline
- D.
Refer to KidCare
Correct Answer
C. Refer to the MediKids HelplineExplanation
The correct answer is to refer the caller to the MediKids Helpline. This implies that the caller is seeking information or assistance related to children's health or medical care. By referring them to the MediKids Helpline, the caller can get the appropriate guidance and support they need for their child's plan or situation.Rate this question:
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- 19.
Why is the member Excluded for MMA?
- A.
The member is enrolled in PACE and will receive medical and long-term care services from PACE.
- B.
The member has a TPL on file and will receive all services through the private insurance.
- C.
The member receives Medicaid through the SSA and is disabled, so they can use FFS Medicaid.
- D.
It is an error, the member qualifies to enroll in LTC and MMA.
Correct Answer
A. The member is enrolled in PACE and will receive medical and long-term care services from PACE.Explanation
The member is excluded for MMA because they are already enrolled in PACE, which provides both medical and long-term care services. MMA is not necessary for this member as they are already receiving the required services through PACE.Rate this question:
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- 20.
Mary does not want to be enrolled in a managed care plan anymore. She prefers to receive services using straight Medicaid because they have better doctors and she does not have to get referrals to see her specialist. How do you proceed?
- A.
Submit a MC Exemption request to AHCA because the recipient wants straight Medicaid.
- B.
File a complaint against AHCA. Florida statute states recipients have the right to choose a managed care plan or straight Medicaid.
- C.
Submit a Supervisor Task for SNU because the caller needs to see her specialists.
- D.
Explain to the caller that she must be enrolled in a managed care plan in order to receive services. Tell the caller when the plan can be changed and refer to the plan if the caller is having difficulty seeing providers or receiving services.
Correct Answer
D. Explain to the caller that she must be enrolled in a managed care plan in order to receive services. Tell the caller when the plan can be changed and refer to the plan if the caller is having difficulty seeing providers or receiving services.Explanation
The correct answer is to explain to the caller that she must be enrolled in a managed care plan in order to receive services. This is because the caller prefers to receive services using straight Medicaid, but it is necessary to be enrolled in a managed care plan. The explanation should also include information on when the plan can be changed and refer to the plan if the caller is having difficulty seeing providers or receiving services.Rate this question:
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- 21.
Which of the following is Voluntary for an MMA enrollment?
- A.
Recipients that receive Supplemental Security Income
- B.
Recipients with APD
- C.
Recipients with Medicare
- D.
Recipients that are in foster care
Correct Answer
B. Recipients with APDExplanation
Recipients with APD refers to individuals with Acquired Physical Disabilities. The question is asking which group of recipients is voluntary for an MMA enrollment. MMA stands for Medicare Modernization Act, which is a federal law that provides prescription drug coverage to Medicare beneficiaries. Since APD is not mentioned in relation to any mandatory enrollment or requirement for MMA, it can be inferred that recipients with APD have the choice to enroll in MMA, making it a voluntary option for them.Rate this question:
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- 22.
If the CMS special condition expires...
- A.
Then the child will have 60 days to continue to recieve services from CMS.
- B.
Then the child has been cured of the special condition.
- C.
Then the child can enroll into CMS.
- D.
Then the child will be disenrolled from CMS.
Correct Answer
D. Then the child will be disenrolled from CMS.Explanation
If the CMS special condition expires, it means that the child's eligibility for CMS services related to that special condition has ended. Therefore, the child will be disenrolled from CMS.Rate this question:
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- 23.
Flora says she received a letter saying she is Medicaid eligible and she wants to choose a plan. She has been advised that the type of Medicaid she has will not allow her to enroll into a plan. Flora wants to know what kind of Medicaid she has and what she needs to do about health coverage. What information should be provided to Flora?
- A.
Tell Flora, she can't choose a plan and discontinue the call.
- B.
Submit a discrepancy log to request for Flora to be enrolled into a plan.
- C.
Advise Flora that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare.
- D.
Advise Flora that she can't pick a plan because she has FFS.
Correct Answer
C. Advise Flora that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare.Explanation
The correct answer is to advise Flora that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare. This means that Flora cannot choose a separate plan for Medicaid coverage, but she can rely on her existing Medicare coverage with the added support of Medicaid for certain expenses.Rate this question:
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- 24.
According to the eligibility information in the hover, this recipient would be __________ for MMA.
- A.
Mandatory
- B.
Voluntary
- C.
Excluded
Correct Answer
C. ExcludedExplanation
Based on the given information, the recipient would be excluded for MMA. This means that they are not eligible for MMA.Rate this question:
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- 25.
The child is being auto-assigned to the plan below. What special condition was recently updated to the case?
- A.
Diabetes
- B.
Serious Mental Illness
- C.
CMS
- D.
Homesafenet
Correct Answer
D. Homesafenet -
.png "Why is the recipient listed below Excluded from enrolling into a LTC plan?")
.png "Why is the recipient below categorized as Voluntary?")
.png "The recipient's mother calls in to enroll her son into a plan. Is the recipient eligible to enroll into a managed care plan?")
.PNG "Why is the member Excluded for MMA?")
.PNG "According to the eligibility information in the hover, this recipient would be __________ for MMA.")
.PNG "The child is being auto-assigned to the plan below. What special condition was recently updated to the case?")
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Mar 21, 2023Quiz Edited by
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Sep 22, 2014Quiz Created by
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