Supervisor And Team Lead Quiz 11-19-20-2014

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Questions: 10 | Attempts: 61

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Supervisor And Team Lead Quiz 11-19-20-2014 - Quiz



Questions and Answers
  • 1. 

    Mom calls in on 11/12/14 to enroll her newborn into Humana and assign the child's pediatrician. You see in HealthTrack there is a current enrollment into Humana effective 11/01/2014. How should you proceed? 

    • A.

      Place the request on the Discrepancy Log.

    • B.

      Process a plan change to Humana through the SMMC wizard.

    • C.

      Inform mom to call Humana to assign the pcp.

    Correct Answer
    C. Inform mom to call Humana to assign the pcp.
    Explanation
    Based on the information provided, there is already a current enrollment into Humana effective 11/01/2014. Therefore, the best course of action would be to inform mom to call Humana to assign the child's pediatrician. This is because the enrollment has already been processed and the only remaining step is for mom to contact Humana directly to assign the pediatrician.

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  • 2. 

    Mother calls to select a plan for the child. How do you proceed?

    • A.

      Process request through the SMMC wizard.

    • B.

      Place the request on the Discrepancy Log.

    • C.

      Inform mom to call back on 12/01/2014.

    • D.

      Refer mom to DCF to confirm eligibility.

    Correct Answer
    A. Process request through the SMMC wizard.
    Explanation
    The correct answer is to process the request through the SMMC wizard. This means that the mother should go through the SMMC (Statewide Medicaid Managed Care) wizard to select a plan for the child. The SMMC wizard is a tool or system that helps guide individuals through the process of selecting a Medicaid managed care plan. By using the SMMC wizard, the mother will be able to choose the most suitable plan for her child's needs.

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  • 3. 

    The member below states he does not have HIV/AIDS. He insists that the special medical condition be taken off his case because he does not want to be enrolled into Clear Health Alliance HIV/AIDS Specialty Plan. How do you proceed?

    • A.

      Refer the member to DCF to have the condition removed.

    • B.

      File a Complaint (Special Condition Update).

    • C.

      Place the request on the Discrepancy Log to be removed.

    Correct Answer
    B. File a Complaint (Special Condition Update).
    Explanation
    The correct answer is to file a complaint (Special Condition Update). By filing a complaint, the member's request to have the special medical condition removed can be addressed and processed accordingly. This ensures that the member's concerns are acknowledged and the necessary actions are taken to address their request. Referring the member to DCF or placing the request on the discrepancy log may not be the appropriate course of action in this situation.

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  • 4. 

    In HealthTrack, the member's medicaid eligibility and current plan are ending 11/30/2014. In FMMIS, the member will have a new ACWM code effective 12/01/2014. The member calls in after cut-off and wants to remain enrolled in current plan for 12/01/2014. How do you proceed?

    • A.

      Place the request on the Discrepancy Log.

    • B.

      Process the request through the SMMC wizard. Contact Marsha immediately to process an early effective date.

    • C.

      Explain reinstatement process to member.

    • D.

      Process request through SMMC wizard for a 01/01/2014 effective date.

    Correct Answer
    B. Process the request through the SMMC wizard. Contact Marsha immediately to process an early effective date.
    Explanation
    The member's medicaid eligibility and current plan are ending on 11/30/2014, and in FMMIS, the member will have a new ACWM code effective 12/01/2014. The member wants to remain enrolled in their current plan for 12/01/2014. In this situation, the appropriate course of action would be to process the request through the SMMC wizard and contact Marsha immediately to process an early effective date. This will ensure that the member can continue to be enrolled in their current plan for the requested date.

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  • 5. 

    The member below called in to change her plan to Staywell. She calls back before cut-off and states she wants to remain in her current plan. How do you proceed?

    • A.

      Process request through the SMMC wizard for a 01/01/2015 effective date.

    • B.

      Place the request on the Discrepancy Log.

    • C.

      Process request through the SMMC wizard for a 12/01/2014 effective date.

    Correct Answer
    C. Process request through the SMMC wizard for a 12/01/2014 effective date.
  • 6. 

    The member below has an auto-assignment with an effective date of 12/01/2014. The member calls the day after the cut-off day to enroll into a plan. How do you proceed?

    • A.

      Process the request through the SMMC wizard.

    • B.

      Place the enrollment request on the discrepancy log for a 12/01/2014 effective date.

    • C.

      Place the enrollment request on the discrepancy log to be processed for a 01/01/2014 effective date.

    Correct Answer
    C. Place the enrollment request on the discrepancy log to be processed for a 01/01/2014 effective date.
  • 7. 

    The member below calls in before the cut-off date to process a plan change to Staywell. She later calls back after cut-off and states she needs to remain in United. She has an appointment with her specialist in December and this is the only plan her specialist takes. How do you proceed?  

    • A.

      Place the request on the Discrepancy Log.

    • B.

      Process a plan change through the SMMC wizard. Send an email request for an earlier effective date to Marsha and copy Lisa.

    • C.

      Inform the caller that the plan cannot be back dated at this time.

    • D.

      Process the request through the wizard and explain to the member that United will be effective again in January.

    Correct Answer
    B. Process a plan change through the SMMC wizard. Send an email request for an earlier effective date to Marsha and copy Lisa.
    Explanation
    Based on the given scenario, the member initially requested a plan change to Staywell before the cut-off date. However, she later realized that she needs to remain in United because her specialist only accepts this plan and she has an appointment with the specialist in December. To address this situation, the best course of action is to process a plan change through the SMMC wizard. Additionally, an email should be sent to Marsha and Lisa requesting an earlier effective date for the plan change. This will ensure that the member can continue with United and attend her specialist appointment in December.

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  • 8. 

    Caller calls in and states she wants her daughter to remain in her current plan of Molina. How do you proceed?

    • A.

      Convert the pending request to a voluntary choice.

    • B.

      Cancel the pending request.

    • C.

      Place the request on the Discrepancy Log.

    • D.

      Convert the current enrollment to a voluntary choice.

    Correct Answer
    D. Convert the current enrollment to a voluntary choice.
    Explanation
    If the caller wants her daughter to remain in her current plan of Molina, the best course of action would be to convert the current enrollment to a voluntary choice. This means that the daughter will have the option to continue with her current plan instead of being automatically enrolled in a different plan. This allows the caller to maintain her daughter's preference while still giving her the flexibility to choose a different plan if desired.

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  • 9. 

    The member below was recently disenrolled from her plan. She calls in and wants to know why she was disenrolled. She also wants to enroll into a plan again. How do you proceed?

    • A.

      Refer member to DCF to have TPL 19 removed.

    • B.

      Place the request on the Discrepancy Log.

    • C.

      Explain to the member she is no longer able to be enrolled into a plan.

    Correct Answer
    C. Explain to the member she is no longer able to be enrolled into a plan.
    Explanation
    The correct answer is to explain to the member that she is no longer able to be enrolled into a plan. This is the appropriate response because the member has been disenrolled from her plan, and therefore cannot be enrolled again. Providing an explanation to the member will help her understand the situation and prevent any confusion or frustration.

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  • 10. 

    Member calls in on November 21, 2014 to process a plan change to Amerigroup. At the end of the call, when provided the effective date, she states she needs Amerigroup to become effective ASAP. She has an appointment in December and this is the only plan her provider accepts. How do you proceed?

    • A.

      Cancel the pending request. Send a email request for an earlier effective date to Marsha and copy Lisa.

    • B.

      Inform the caller that the plan cannot be back dated at this time.

    • C.

      Place the request on the Discrepancy Log.

    Correct Answer
    A. Cancel the pending request. Send a email request for an earlier effective date to Marsha and copy Lisa.

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