Wellcare 2023 Questions and Answers with Certified Solutions

Wellcare 2023 Questions and Answers with Certified Solutions Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. Select 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 To ensure accurate data entry, you should repeat the Medicare ID back to the beneficiary. Select one: True False True Key areas you as an agent have control over and impact upon regarding Star Ratings for quality are: a. Member Satisfaction/Experience b. Complaints c. Rapid Disenrollment d. All of the above All of the above Wellcare added ___ counties to their footprint for 2023. a. 122 b. 209 c. 284 d. 327 209 ____ PDPs will be offered across all 50 U.S. states and Washington, D.C. a. Two b. Three c. Four d. Five Three All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies. Select one: True False True Value Script and Value Plus PDP products have a ___-tier formulary structure for 2023. a. 3 b. 4 c. 5 d. 6 6 Centene's 2023 product expansion represents a __% increase from 2022. a. 1 b. 2 c. 3 d. 5 3 The _________ plan is expected to have one of the lowest premiums in the country! a. Classic b. Value Plus c. Value Script Value Script For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions. a. Classic b. Value Plus c. Value Script Value Plus 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. Select one: True False True There are ___ LIS copay categories that could be assigned to a member, depending on the level of need. a. two b. three c. four d. five Four All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order). Select one: True False True Which standalone Prescription Drug Plan is best for a dual-eligible chooser? a. Value Script b. Value Plus c. Classic Classic The Wellcare preferred pharmacy network includes Walgreens, CVS, and many grocery chains in 2023. Select one: True False True