Smmc Refresher Quiz #9

7 Questions | Total Attempts: 151

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Smmc Refresher Quiz #9

Verification


Questions and Answers
  • 1. 
    A father calls to change his child’s plan. When you access the case, you see the father is 17 years old. How should you proceed?
    • A. 

      Provide the fax number and advise the father that he will need to fax in legal documentation that he is emancipated before we can continue.

    • B. 

      Continue with verification and determine if a plan change is possible.

    • C. 

      Provide the fax number and advise the father that he will need to fax in documentation that he is the legal guardian of the child.

    • D. 

      Advise the father we cannot speak to minors and ask to speak to an adult.

  • 2. 
    A member needs to change the plan, but during verification you are informed there is someone else on the line. They introduce themselves as a representative from Sunshine Health. How should you proceed?
    • A. 

      Ask the member if it is OK to proceed with the representative on the line.

    • B. 

      Inform the representative that they will need to complete a DAR form. Offer to send the DAR via email, mail or fax and then continue with verification.

    • C. 

      Advise the member we cannot continue with a health plan representative on the line, and advise the member to call back for assistance.

    • D. 

      Document the representative’s Name, Agency & Title, work phone number, and ask them to provide detail on how they are authorized.

  • 3. 
    A member completes verification and gives permission for their mother to take over the call. How should you proceed?
    • A. 

      Advise the member that their mother will need to complete verification before we continue.

    • B. 

      Inform the member that their mother will need to complete a DAR form. Offer to send the DAR via email, mail or fax and then continue with verification.

    • C. 

      Tell the member we can’t speak to anyone else since they already verified their information and can obviously speak for themselves.

    • D. 

      Continue the call with their mother. A member can authorize someone else to speak on their behalf after verification.

  • 4. 
    A parent needs to change the plan for their child. When verifying the year of birth, the parent verifies 2016 instead of the year on the case (2015). How should you proceed?
    • A. 

      Continue with verification. The parent does not have to verify the correct year of birth.

    • B. 

      Inform the parent that they are close, and ask them to try again. Keep hinting until they get the year of birth correct and then proceed with verification to determine if a plan change is possible.

    • C. 

      Advise the parent that we cannot continue the call because they provided incorrect information. Refer to the AHCA Medicaid Helpline to file a complaint.

    • D. 

      Advise the parent that the year of birth they provided is not what we have on file. If they are unable to verify the year of birth after being informed what they provided was incorrect, refer to DCF. DCF will be able to verify what year of birth is listed in the state system and update it if necessary.

  • 5. 
    The member does not have their Medicaid ID or Gold Card number. What is the next number you can ask for to attempt to access the case?
    • A. 

      A Case Number.

    • B. 

      A Medicare ID Number.

    • C. 

      A Social Security Number.

    • D. 

      A Credit Card Number.

  • 6. 
    The caller states, “I’m calling on behalf of my neighbor. She’s elderly and recently had a stroke so it is difficult for her to communicate. She has asked me to help enroll her into a plan. I’m not her legal representative, but she gave me permission to help her and I have all of her information here.” How should you proceed?
    • A. 

      Ask the caller for the PIN. If they cannot verify the PIN, advise them to send in a DAR form. Offer to send the DAR via email, mail, or fax and then continue with verification.

    • B. 

      Advise the caller we are unable to continue the call because they stated they are not legally authorized to speak on the member’s behalf.

    • C. 

      Advise the caller we would need the member to verify the information on the case and then verbally authorize the caller to speak on their behalf before we could continue.

    • D. 

      Ask the caller for the PIN. If they cannot verify the PIN, then continue with verification since they stated they received permission from the member.

  • 7. 
    This mother needs to change the plan for her child. How should you proceed? 
    • A. 

      Ask the mother for the PIN. If she cannot verify the PIN, advise her to send in a DAR form. Offer to send the DAR via email, mail, or fax and then continue with verification.

    • B. 

      Provide the fax number and advise the mother that she will need to fax in documentation that she is the legal guardian of the child.

    • C. 

      Ask the mother for the PIN. If she cannot verify the PIN, then continue with verification since she stated she is the parent.

    • D. 

      Inform the mother we will need to verify the case information with the member, and will need verbal authorization from the member that she can speak on her daughter’s behalf before we can continue.

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