Supervisor And Team Lead Quiz 12/17-18/14

10 Questions | Total Attempts: 45

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Supervisor And Team Lead Quiz 12/17-18/14

Questions and Answers
  • 1. 
    Agent says: I have a recipient on the phone that is being auto-assigned to Freedom Health, but they have a TPL 19 and the caller is stating they should not have to choose a plan. What should you advise the agent?
    • A. 

      Advise the agent to place this on the discrepancy log.

    • B. 

      Escalate this to Marsha and Lisa because the recipient should be excluded with TPL 19

    • C. 

      Advise the agent to tell the caller that due to the type of Medicaid that is on file, they will need to select a plan.

    • D. 

      Advise the agent to verify if the recipient has a special condition on file to determine if the caller is eligible to enroll with that plan.

  • 2. 
    Agent says:  I have a caller on my line that states they need to keep going to a particular Pharmacy in their area because this pharmacy is the only one carrying their heart medication.  The caller is locked-in and states they have been filling their prescriptions there for 10 years but the pharmacy will not allow them to pick up the prescription since we gave them this plan. How would you tell the agent to proceed?
    • A. 

      Tell the agent to tell the caller to call the plan to find another pharmacy accepts the plan and carries the medication.

    • B. 

      Submit a supervisor task.

    • C. 

      Advise the agent to complete a GC9.

    • D. 

      Find Marsha or Lisa because they should be able to escalate this to AHCA.

  • 3. 
    Agent says:  This recipient says they need to change their plan because they can't see their Therapy provider.  The plan they are enrolled with is Sunshine Health Plan.  The recipient is locked in but I see under Sunshine there are other Therapy providers listed but the caller insists that Sunshine has no Therapy providers that she can go to.  What would you advise your agent?
    • A. 

      Tell the agent to tell the caller to file a grievance with the plan.

    • B. 

      Tell the agent to advise the caller to contact the plan again.

    • C. 

      Advise the agent to process a plan change using a GC1.

  • 4. 
    Agent says: I have a caller on the phone that is locked into Sunshine Health Plan.  The caller wants to get out of the plan because they can no longer see their PCP.  I remember a Heads Up went out saying we can use a GC1 to process this plan change.  Should I just use the GC1?
    • A. 

      Advise the agent to review the Heads Up, and more information is needed to verify if this recipient qualifies for a GC1.

    • B. 

      Advise the agent to process a plan change using a GC1

    • C. 

      Advise the agent to process the plan change using a GC1610

  • 5. 
    If a caller states their Therapy provider is no longer accepting their Sunshine Health, since there was a Heads Up sent out about this, we do not have to verify when the provider advised they were no longer accepting the plan with the caller.
    • A. 

      True

    • B. 

      False

  • 6. 
    When is the cut-off day for MMA?
    • A. 

      The cut-off day is the Thursday before the 2nd to the last Saturday of every month.

    • B. 

      The cut-off day is the second to the last day of the month.

    • C. 

      The cut-off is immediately after the green check mark appears in HealthTrack.

    • D. 

      The cut-off is the last day of the month.

  • 7. 
    When is the cut-off date for LTC?
    • A. 

      The cut-off date is the 2nd to the last day of the month.

    • B. 

      The cut-off is the last day of the month

    • C. 

      The cut-off is the Thursday before the 2nd to the last Saturday of the month.

    • D. 

      The cut-off is immediately after the green check mark appears in HealthTrack.

  • 8. 
    Agent says:  I have a recipient that needs to enroll into a plan but HealthTrack will not allow me to do it.  There is an Auto-Assignment into United and the caller wants United. It is before the cut-off date.  What would you advise your agent to do?
    • A. 

      Advise your agent to place this on the discrepancy log.

    • B. 

      Advise your agent to advise the caller of the effective date on the Auto-Assignment.

    • C. 

      Advise your agent to submit a supervisor task so you can escalate this because HealthTrack is not working. Tell everyone the system is down.

  • 9. 
    Agents says:  This recipient on the phone is going to be Auto-Assigned to Freedom Health(Specialty Plan).  The recipient wants this plan but it is not showing up in the wizard for me to enroll the recipient. What should I do?
    • A. 

      Advise the agent to submit a supervisor task for further research.

    • B. 

      Advise the agent, if the recipient wants the auto-assignment into Freedom, select accept assignment.

    • C. 

      Advise the agent to place this on the discrepancy log for processing.

  • 10. 
    If a caller is not eligible for Freedom Health (Specialty Plan) but feels they should be eligible  to enroll, what should you do?
    • A. 

      Advise the caller to contact DCF.

    • B. 

      Advise the caller to contact the AHCA Medicaid Helpline.

    • C. 

      Refer the caller to Freedom Health.

    • D. 

      Place this on the discrepancy log.

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