Centene ACT ME Review Questions and Answers with Complete Solutions

Centene ACT ME Review Questions and Answers with Complete Solutions Agents may be investigated after being suspected of noncompliant activity reported through a Complaint Tracking Module (CTM), grievance, secret shop finding, internal audit or reporting. True Which of the following health plans are now available through Centene Corporation? Select the best answer. Health Net, Fidelis Care, Allwell, Ascension Complete, WellCare True or False: The four stages of coverage are NOT the same for PDP and MAPD. False True or False: PII stands for Personally Identifiable Information and includes any information that permits the identity of an individual to be inferred, including information linked or linkable to the individual. True True or False: When enrolling a beneficiary, you should ensure that you enter the provider ID of a specialist and not a primary care physician (PCP). False True or False: An agent could 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. True True or False: A complaint or violation that could not be proven and where no pattern of compliance issues exists is a founded complaint. False Beneficiaries who are first eligible for Medicare have a seven-month Initial Enrollment Period to enroll in a Medicare Advantage Plan. If eligible for Medicare, beneficiaries can sign up during the seven-month period that: All the above True or False: Centene will offer 6 Part D standalone plans in all 34 regions across all 50 states; 204 plans nationwide. True True or False: For plan year 2021, our PPO offerings have doubled True Which of the following is not an ancillary benefit on Centene's Medicare Advantage plans? Personal shopping services True or False: The Minimum Necessary Rule within the Privacy Rule requires that any request or distribution of PHI includes only the minimum amount of PHI required to complete the intended task. This includes email and physical distribution. True OEP runs from January 1 to March 31. Which of the following statements apply: All the above The NEW Part D Senior Savings Model (SSM) _____ member spending on insulin. Reduces True or False: Upon completion of the application, you must provide the beneficiary with the enrollment application confirmation ID. True Generics and brand name drugs are covered on which Part D drug tiers? All of the above True or False: The Centene and WellCare integration offers a wide variety of products/ plan offerings to your client. True True or False: Per CMS, all telephonic enrollment must be completed on a recorded call. True True or False: If the application is being completed by an authorized representative, all corresponding fields must be completed. True Which of the following are plans offered by Centene for beneficiaries that have special needs? Both DSNP and CSNP Across Centene's nationwide Medicaid and Medicare footprint, we serve: 1 in 15 Americans Communication of PHI can be: All of the above Which of the following are examples of Protected Health Information (PHI)? Medical Records & Payment History Excluding Fidelis Care, a member or member's representative must submit a grievance request or evidence concerning a grievance 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. 60 Which stage of coverage is referred to as the 'donut hole' as the member is paying the most for drug coverage? Coverage Gap (Stage 3) When should you verify a beneficiary's eligibility for D-SNP? Before the enrollment True or False: Centene currently serves over 23 million Managed Care members. True True or False: Ancillary benefits are the same in every plan across all markets? False True or False: The NEW Rx Plus plans provide cross sell option for beneficiaries currently in a standalone PDP product who might benefit from lower medical cost shares by using in- network providers. True In 2021, Centene is offering which of the the following types of Medicare Advantage Prescription Drug (MAPD) products? HMO, HMO/POS, DSNP, CSNP, PPO & PFFS Verbal permission granted to discuss plan details qualifies an authorized representative to complete an application on behalf of the beneficiary. True Wellcare has expanded coverage in Massachusetts, Nebraska