Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing.
Select
... [Show More] one:
True
False
True
Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity?
a. Speak with the investigator as quickly as possible.
b. Answer all questions honestly and completely.
c. Offer information and documents important to the investigation.
d. All of the above
All the above
By selecting the correct provider during the enrollment process, you can:
a. Increase member satisfaction.
b. Ensure timely access to the member's PCP.
c. Minimize call volumes/complaints.
d. All of the above
All the above
Centene requires all contracted agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy.
Select one:
True
False
True
Which of the following is not an example of Protected Health Information (PHI)?
a. Medical records
b. Payment history
c. Library card
Library card
Communication of PHI can be:
(Select all that apply.)
a. Written
b. Electronic
c. Verbal
Written, Electronic, Verbal
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?
a. Member Service
b. Reputation
c. Member Payments
d. Serving Government Customers
Member Payments
Verbal permission granted to discuss plan details qualifies an authorized representative to complete an application on behalf of the beneficiary.
Select one:
True
False
False
Agents may be investigated after being suspected of noncompliant activity reported through a:
(Select all that apply.)
a. Complaint Tracking Module (CTM)
b. Yelp Review
c. Grievance
d. Secret Shop Finding
Complaint Tracking Module (CTM), Grievance, Secret Shop Finding
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.
Select one:
True
False
True
The information contained within ACT will equip agents to certify, market, and sell which health plans?
a. Ascension Complete
b. Wellcare
c. All of the above
All of the above
An agent who has never had any verbal warnings cannot be issued a Corrective Action Plan.
Select one:
True
False
False
Once the enrollment is completed, you can save a copy of the application for your reference.
Select one:
True
False
False
What are some examples of what can trigger a beneficiary complaint?
(Select all that apply.)
a. Did not consent to enroll in the plan.
b. Received incorrect plan benefit information or were dissatisfied with plan benefits.
c. Had enrollment/disenrollment issues (e.g., disenrollment/cancellation requests, late enrollment penalty, loss of entitlement).
d. Were misled about which providers were in-network.
Did not consent to enroll in the plan,
Received incorrect plan benefit information or were dissatisfied with plan benefits,
Were misled about which providers were in-network
Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud.
Select one:
True
False
False
When completing an application, you should ensure that you enter the provider ID of a specialist and not a primary care physician (PCP).
Select one:
True
False
False [Show Less]