By selecting the correct provider during the enrollment process, you can: -
ANSWER All of the above
A grievance request, or any evidence
... [Show More] concerning a grievance, must be fi led orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue. –
ANSWER 60
The Single Sign-On Portal provides access to several applications, including Centene Workbench. –
ANSWER True
Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation. - ANSWER True
Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a: -
ANSWER -Complaint Tracking Module (CTM)
-Grievance
-Secret Shop Finding
The NEW online Centene Workbench self-service portal enables you to: -
ANSWER All of the above
When discussing prescription drug coverage, you should: -
ANSWER -Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits).
-Confirm coverage of the beneficiary's current and/or anticipated prescriptions.
-Explain formulary tiers as well as drug copayment amounts.
-For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception.
Once the enrollment is completed, you can save a copy of the application for your reference. –
ANSWER False
A Health Risk Assessment (HRA) can be completed for C-SNP and D-SNP plans only, before the enrollment application process in Ascend through the Value Based Enrollment (VBE) portal. –
ANSWER False
Which resources are available for download from the Shared Resources section found within Centene Workbench? –
ANSWER All of the above
During an appointment, you may not discuss any products not agreed to in advance by the beneficiary. –
ANSWER True
A broker/agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information. –
ANSWER True
A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. –
ANSWER False
Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. –
ANSWER False
When a paper SOA form is used, it must be completed __________ hosting the sales presentation. –
ANSWER Prior to
Prior to completing the enrollment form, you should always confirm the beneficiary's primary care physician (PCP) and/or specialists. –
ANSWER True
Which of the following statements about Scope of Appointment (SOA) is FALSE? –
ANSWER An electronic SOA submitted in Ascend must be in a Pending status prior to beginning the appointment.
The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). –
ANSWER True
Centene's 2023 product expansion represents a __% increase from 2022. –
ANSWER 3
For 2023, Ascension Complete added 27 new counties to their footprint. –
ANSWER True
For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions. –
ANSWER Value Plus
Wellcare added ___ counties to their footprint for 2023. –
ANSWER 209
The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on all Value Script, Value Plus PDPs, and select Wellcare MAPD plans. –
ANSWER True
____ PDPs will be offered across all 50 U.S. states and Washington, D.C. –
ANSWER Three
Which standalone Prescription Drug Plan is best for a dual-eligible chooser? –
ANSWER Classic
All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies. –
ANSWER True
All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order). –
ANSWER True
The _________ plan is expected to have one of the lowest premiums in the country! –
ANSWER Value Script
There are ___ LIS copay categories that could be assigned to a member, depending on the level of need. –
ANSWER four
Centene has new PPO D-SNP product expansion in CT, IN, KS, KY, MS, OH, OK, PA, SC, and a new HMO D-SNP in LA. –
ANSWER True
What are some examples of steps that can be taken when safeguarding and securing PHI and PII? –
ANSWER -Shred documents that contain PHI or PII using appropriate means.
-Never leave laptops, PHI, or PII in an unattended vehicle.
-Do not include PHI or PII in the subject line or body of an email.
-Secure emails that contain PHI or PII.
A Health Risk Assessment (HRA): -
ANSWER All of the above
Wellcare offers a range of Medicare plans to provide members with affordable access to: -
ANSWER All of the above
Which option is the preferred method to submit enrollment? –
ANSWER Ascend Web/Mobile Application
What are some examples of what can trigger a beneficiary complaint? –
ANSWER -Did not consent to enroll in the plan.
-Received incorrect plan benefit information or were dissatisfied with plan benefits.
-Had enrollment/disenrollment issues (e.g., disenrollment/cancellation requests, late enrollment penalty, loss of entitlement).
-Were misled about which providers were in-network.
Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task. –
ANSWER True
______ events are designed to inform the people that attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. –
ANSWER Educational
Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. –
ANSWER True
Which of the following is not an example of Protected Health Information (PHI)? –
ANSWER Library card
Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. –
ANSWER True
Brokers/Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare Products. –
ANSWER True
Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? –
ANSWER Member Payments
Value Script and Value Plus PDP products have a ___-tier formulary structure for 2023.
- ANSWER 6
Centene continues to expand its reach by offering more products in a wider geography. ____ new Wellcare and Ascension Complete plans are going to market. –
ANSWER Forty-eight
The Wellcare preferred pharmacy network includes Walgreens, CVS, and many grocery chains in 2023. –
ANSWER True
Brokers/Agents can submit a support ticket online through their Centene Workbench portal. –
ANSWER True
What type of inquiries can Wellcare's Corporate Sales Support team assist with? –
ANSWER All of the above
Beneficiary-facing content that includes generic or plan-specific product or benefit information must be submitted for review and CMS submission, as well as acceptance or approval, prior to distribution. –
ANSWER True
Low-Income Subsidy (LIS)/Medicaid Lookup status verification in Ascend is: -
ANSWER -Available for LIS level searches in all states.
-Available for Medicaid status searches in select states.
-A way to assist brokers/agents with enrolling beneficiaries into the right plan based on their extra help status.
Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. –
ANSWER 1
Health plan fax numbers vary for health plans that offer fax enrollment submissions. –
ANSWER True
Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (Formal & Informal). - ANSWER False
Communication of PHI can be: -
ANSWER -Written
-Electronic
-Verbal
Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? –
ANSWER All of the above
Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: -
ANSWER All of the above
Wellcare must receive notice of an event change or cancellation as soon as possible, but no later than 30 minutes after the event start time. –
ANSWER False
You can help prevent grievances by: -
ANSWER -Always confirming availability of the beneficiary's primary and specialist providers by using the provider search tool available on the plan's website.
-Always using plan materials to clearly explain plan benefits and cost (including medications) and check for understanding.
-Always confirming a beneficiary's intent to enroll before accepting their enrollment application. [Show Less]