Smmc: Healthtrack Member Information

25 Questions | Total Attempts: 223

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Smmc: Healthtrack Member Information

Questions and Answers
  • 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.

  • 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.

  • 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

  • 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.

  • 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.

  • 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.

  • 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.

  • 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

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 16. 
    This member needs to update their address, where should they call?
    • A. 

      AHCA

    • B. 

      DOEA

    • C. 

      DCF

    • D. 

      SSA

  • 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.

  • 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

  • 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.

  • 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.

  • 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

  • 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.

  • 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.

  • 24. 
    According to the eligibility information in the hover, this recipient would be  __________ for MMA. 
    • A. 

      Mandatory

    • B. 

      Voluntary

    • C. 

      Excluded

  • 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

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