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

1. 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.

True

False

The statement suggests that if a caller informs that their therapy provider is no longer accepting Sunshine Health, and there was a prior notification about it, there is no need to verify with the provider when they actually stopped accepting the plan. However, this is incorrect. It is always important to verify the information provided by the caller with the therapy provider to ensure accuracy and to avoid any miscommunication or misunderstanding. Therefore, the correct answer is False.

Explanation

The statement suggests that if a caller informs that their therapy provider is no longer accepting Sunshine Health, and there was a prior notification about it, there is no need to verify with the provider when they actually stopped accepting the plan. However, this is incorrect. It is always important to verify the information provided by the caller with the therapy provider to ensure accuracy and to avoid any miscommunication or misunderstanding. Therefore, the correct answer is False.

2. 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?

Advise your agent to place this on the discrepancy log.

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

The correct answer is to advise the agent to inform the caller of the effective date on the Auto-Assignment. This is because the caller wants to enroll in the United plan, but the agent is unable to do it through HealthTrack. By informing the caller about the effective date on the Auto-Assignment, the caller can make an informed decision about whether to proceed with the enrollment or wait for the desired plan.

Explanation

The correct answer is to advise the agent to inform the caller of the effective date on the Auto-Assignment. This is because the caller wants to enroll in the United plan, but the agent is unable to do it through HealthTrack. By informing the caller about the effective date on the Auto-Assignment, the caller can make an informed decision about whether to proceed with the enrollment or wait for the desired plan.

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

Advise the caller to contact DCF.

Advise the caller to contact the AHCA Medicaid Helpline.

Refer the caller to Freedom Health.

Place this on the discrepancy log.

If a caller is not eligible for Freedom Health (Specialty Plan) but feels they should be eligible to enroll, the best course of action is to refer the caller to Freedom Health. This means that the caller should be directed to contact Freedom Health directly for further assistance and clarification regarding their eligibility for enrollment.

Explanation

If a caller is not eligible for Freedom Health (Specialty Plan) but feels they should be eligible to enroll, the best course of action is to refer the caller to Freedom Health. This means that the caller should be directed to contact Freedom Health directly for further assistance and clarification regarding their eligibility for enrollment.

4. 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?

Submit a supervisor task.

Advise the agent to complete a GC9.

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

The correct answer is to advise the agent to complete a GC9. This is because the caller is unable to pick up their prescription from their usual pharmacy due to a change in their plan. Completing a GC9 form would allow the agent to document the situation and escalate it for further assistance or resolution.

Explanation

The correct answer is to advise the agent to complete a GC9. This is because the caller is unable to pick up their prescription from their usual pharmacy due to a change in their plan. Completing a GC9 form would allow the agent to document the situation and escalate it for further assistance or resolution.

5. When is the cut-off date for LTC?

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

The cut-off is the last day of the month

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

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

The correct answer is that the cut-off date for LTC is the last day of the month. This means that any transactions or requests related to LTC must be completed before the end of the month in order to be considered for processing.

Explanation

The correct answer is that the cut-off date for LTC is the last day of the month. This means that any transactions or requests related to LTC must be completed before the end of the month in order to be considered for processing.

6. 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?

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

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

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

The correct answer is "Advise the agent, if the recipient wants the auto-assignment into Freedom, select accept assignment." This answer suggests that if the recipient wants to be enrolled in the Freedom Health(Specialty Plan) and it is not showing up in the wizard, the agent should select "accept assignment" to ensure the auto-assignment into Freedom.

Explanation

The correct answer is "Advise the agent, if the recipient wants the auto-assignment into Freedom, select accept assignment." This answer suggests that if the recipient wants to be enrolled in the Freedom Health(Specialty Plan) and it is not showing up in the wizard, the agent should select "accept assignment" to ensure the auto-assignment into Freedom.

7. 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?

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

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

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

The caller is unable to see their therapy provider under their current plan, Sunshine Health Plan. Although there are other therapy providers listed under Sunshine, the caller insists that none of them are available to them. Therefore, the best course of action would be to advise the agent to process a plan change using a GC1 form. This would allow the recipient to switch to a different plan that includes therapy providers that are accessible to them.

Explanation

The caller is unable to see their therapy provider under their current plan, Sunshine Health Plan. Although there are other therapy providers listed under Sunshine, the caller insists that none of them are available to them. Therefore, the best course of action would be to advise the agent to process a plan change using a GC1 form. This would allow the recipient to switch to a different plan that includes therapy providers that are accessible to them.

8. 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?

Advise the agent to process a plan change using a GC1

Advise the agent to process the plan change using a GC1610

The correct answer is to advise the agent to review the Heads Up and gather more information to determine if the caller qualifies for a GC1. This is because the agent remembers receiving information about using a GC1 for this type of plan change, but it is important to verify if the caller meets the criteria for a GC1 before proceeding with the plan change.

Explanation

The correct answer is to advise the agent to review the Heads Up and gather more information to determine if the caller qualifies for a GC1. This is because the agent remembers receiving information about using a GC1 for this type of plan change, but it is important to verify if the caller meets the criteria for a GC1 before proceeding with the plan change.

9. 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?

Advise the agent to place this on the discrepancy log.

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

The correct answer is to 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. This is the most appropriate response as it addresses the specific situation described by the agent. The caller has a TPL 19 and believes they should not have to choose a plan, but the agent should inform them that based on the type of Medicaid they have, selecting a plan is necessary.

Explanation

The correct answer is to 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. This is the most appropriate response as it addresses the specific situation described by the agent. The caller has a TPL 19 and believes they should not have to choose a plan, but the agent should inform them that based on the type of Medicaid they have, selecting a plan is necessary.

10. When is the cut-off day for MMA?

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

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

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

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

The correct answer is "The cut-off is the last day of the month." This is because the other options mention specific days or conditions that do not align with the given information. The first option mentions the Thursday before the 2nd to the last Saturday of every month, which is not the last day. The second option mentions the second to the last day of the month, which is not the last day either. The third option mentions the green check mark in HealthTrack, which is not mentioned in the given information. Therefore, the only option that matches the given information is that the cut-off is the last day of the month.

Explanation

The correct answer is "The cut-off is the last day of the month." This is because the other options mention specific days or conditions that do not align with the given information. The first option mentions the Thursday before the 2nd to the last Saturday of every month, which is not the last day. The second option mentions the second to the last day of the month, which is not the last day either. The third option mentions the green check mark in HealthTrack, which is not mentioned in the given information. Therefore, the only option that matches the given information is that the cut-off is the last day of the month.