Supervisor And Team Lead Quiz 12/3-4/2014

40 Questions | Total Attempts: 40

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Supervisor And Team Lead Quiz 12/3-4/2014

Questions and Answers
  • 1. 
    If an infant is born on November 6, what date will the newborn's plan be effective?
    • A. 

      January 1

    • B. 

      December 1

    • C. 

      October 1

    • D. 

      November 1

  • 2. 
    Members being transitioned from First Coast Advantage to Molina will not receive 90 days to 'try out' the plan.
    • A. 

      True

    • B. 

      False

  • 3. 
    Before the LTC cut-off date, if a LTC auto-assignment has processed and the caller does not want that plan, how should the agent proceed?
    • A. 

      The agent should place the request on the discrepancy log.

    • B. 

      The agent should confirm the auto-assignment and explain that no change can be made at this time.

    • C. 

      The agent should tell the caller to call back after the cut-off date.

    • D. 

      The agent should process the change through the wizard.

  • 4. 
    Special Condition spans: ‘LTC Non-COMP’ and ‘SMMC COMP Enrolled' are added as a member's special condition based on____________?
    • A. 

      LTC or Comprehensive needs.

    • B. 

      MMA Eligibility

    • C. 

      LTC or Comprehensive enrollments.

    • D. 

      LTC Eligibility

  • 5. 
    Where should you refer LTC recipients who need additional assistance with changing from a PACE plan?
    • A. 

      Local Area Office

    • B. 

      Elder Helpline

    • C. 

      CARES

    • D. 

      DCF

  • 6. 
    How will PACE enrollees receive their medical services?
    • A. 

      Through PACE because PACE covers medical and LTC services.

    • B. 

      Through straight medicaid/FFS.

    • C. 

      Through a MMA plan.

    • D. 

      Through a LTC plan.

  • 7. 
    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.

  • 8. 
    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.

  • 9. 
    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.

  • 10. 
    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.

  • 11. 
    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.

  • 12. 
    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.

  • 13. 
    CMS Pre-Pending Request cannot be cancelled. 
    • A. 

      True

    • B. 

      False

  • 14. 
    Indicator: "Recipient Resides in a State Hospital" will appear in what tab in the Span Information? 
    • A. 

      Special Conditions

    • B. 

      Level of Care

    • C. 

      Waiver Program

    • D. 

      APD

  • 15. 
    Recipients that reside in a state hospital will have which member type?
    • A. 

      Excluded

    • B. 

      Mandatory

    • C. 

      Voluntary

  • 16. 
    The Public Session Tab has been added to which website?
    • A. 

      MyFlorida Website

    • B. 

      AHCA Website

    • C. 

      Plan Websites

    • D. 

      SMMC Website

  • 17. 
    Public sessions are...
    • A. 

      Sessions where Choice Counselors are available to meet with members on a more personal basis; to choose the best plan for them.

    • B. 

      Sessions where Choice Counselors are available to meet with members for help with enrolling and general questions.

    • C. 

      Sessions where Choice Counselors are available to meet with anyone to sign them up for Medicaid.

    • D. 

      Sessions where AHCA is available to meet with members about the SMMC program.

  • 18. 
    Where would you log a MediKids discrepancy?
    • A. 

      MediKids Form

    • B. 

      SMMC Discrepancy Log

    • C. 

      SMMC Downtime Form

    • D. 

      MediKids DAR

  • 19. 
    You ask a parent: "Does your child have any special medical needs?"Parent response: "No, but he has a hard time paying attention in school. He's always getting in trouble but I think it's because his father passed away. His teacher thinks he needs some type of therapy. But no medical needs."How would you help this member?
    • A. 

      Disregard the extra information stated by the parent and proceed with the call since the parent answered "No".

    • B. 

      Document the child needs therapy without the parent's knowledge and just refer the parent to CMS for further explaination.

    • C. 

      Advise the caller, "According to the information provided your child may qualify for CMS." Proceed with asking the caller the CMS screening questions.

    • D. 

      Explain to the parent the child might need to enroll into CMS since the teacher said the child needs therapy.

  • 20. 
    Children's Medical Services (CMS) is for children under the age of 21 who have special medical, behavioral, or other health care needs that are expected to last longer than 12 months.
    • A. 

      True

    • B. 

      False

  • 21. 
    Since the implementation of SMMC, siblings are no longer eligible to enroll based on another child's CMS enrollment. Any siblings enrolled under CMS...
    • A. 

      Must provide proof that they are related to the recipient in CMS.

    • B. 

      Must live in the same house as the recipient in CMS.

    • C. 

      Must have an active CMS span in order to remain in CMS.

    • D. 

      Must have a sibling CMS exemption in order to remain in CMS.

  • 22. 
    When will the 90 day trial period start for Med Pending enrollments?
    • A. 

      90 days will start as soon as the plan starts.

    • B. 

      90 days will start on the first month eligibility has been received.

    • C. 

      LTC recipients do not get 90 days to try out the plan.

    • D. 

      90 days will start after open enrolllment.

  • 23. 
    The LTC plan can limit services for recipients that are receiving services without eligibility.
    • A. 

      True

    • B. 

      False

  • 24. 
    What indicator below could have an impact on the plan effective date?
    • A. 

      None. The recipient is Mandatory and has full coverage Medicaid until 12/31/14.

    • B. 

      The recipient has CHIP Medicaid and the plan will automatically start on 8/1/14.

    • C. 

      The recipient has CHIP. They must have active Medicaid in FMMIS for the plan to be effective on 8/1/14.

    • D. 

      This is a HealthTrack error because the eligibility is not in FMMIS. Place on the discrepancy log.

  • 25. 
    What should you do if the HIV/AIDS special condition is not listed in the system? 
    • A. 

      Tell the caller their doctor must update their medical record and report it to AHCA.

    • B. 

      Tell the caller to fax us documentation of the special condition, so the case can be updated.

    • C. 

      Tell the caller they must report their special condition to the Center's for Disease Control and the Department of Health.

    • D. 

      Tell the caller the SNU Nurse will call them to get more information on their special condition and set up a home visit.

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