Supervisor And Team Lead Quiz 11-19-20-2014
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- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
.PNG "Mother calls to select a plan for the child. How do you proceed?")
.PNG "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?")
.PNG "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?")
.PNG "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?")
.PNG "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?")
.PNG "Caller calls in and states she wants her daughter to remain in her current plan of Molina. How do you proceed?")
.PNG "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?")
.PNG "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?")
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