Smmc: Healthtrack Member Information

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.

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.

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.

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.

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.

Based on the given information, the recipient would be excluded for MMA. This means that they are not eligible for MMA.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

not-available-via-ai

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.

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.