Centene Final Midterm Exam Questions With Complete
Solutions Graded A+
How many HIPAA items must be verified when speaking with a prospective
member?
0
Where can you locate rejected Pharmacy Claims if they are not displaying in
Omni?
CVS/COS
You can use the following systems to verify member eligibility, except?
Portico
If a member calls to update their address and it has not been updated in MARx,
we should?
Submit the address change request and direct the member to contact the SSA to
update the address with them.
True or False: When making permanent address update we should inform the
member to also contact Social Security Administration to update their address
with them.
True
Which Omni intent would you use when if a member calls in to ask how much of
their deductible has been met?
Accumulator Inquiry
Which Omni intent will you use to verify if a care Manager / Case Manager is
assigned to a member?
Care management
What am I? '' I received a call from my case manager telling me that my procedure
was denied because of insufficient of some sort. my doctor recommended this
surgery, should that be enough to approve it?'m
Appeal
What are the two main uses for the TruCloud? select two
case management and Authorizations
In Amisys, we can view all EXCEPT
Authorized representatives
When a caller is requesting to speak on behalf of a member, a C SR can get
________ _________ from the member. The 2 HIPAA verifiers must be provided by
the _________, not the caller.
Verbal authorization/ member
In Omni the intent/tasks that are used to update demographics
(address,name,DOB) require the user to first access _________ system to verify
what information it has.
MARx
When a member has other insurance besides Centene's, this is referred to as:
OHI or COB
___________ Grievances require a written response but __________ Grievances
are handled by the CSR AND USUALLY resolved within first call.
Solutions Graded A+
How many HIPAA items must be verified when speaking with a prospective
member?
0
Where can you locate rejected Pharmacy Claims if they are not displaying in
Omni?
CVS/COS
You can use the following systems to verify member eligibility, except?
Portico
If a member calls to update their address and it has not been updated in MARx,
we should?
Submit the address change request and direct the member to contact the SSA to
update the address with them.
True or False: When making permanent address update we should inform the
member to also contact Social Security Administration to update their address
with them.
True
Which Omni intent would you use when if a member calls in to ask how much of
their deductible has been met?
Accumulator Inquiry
Which Omni intent will you use to verify if a care Manager / Case Manager is
assigned to a member?
Care management
What am I? '' I received a call from my case manager telling me that my procedure
was denied because of insufficient of some sort. my doctor recommended this
surgery, should that be enough to approve it?'m
Appeal
What are the two main uses for the TruCloud? select two
case management and Authorizations
In Amisys, we can view all EXCEPT
Authorized representatives
When a caller is requesting to speak on behalf of a member, a C SR can get
________ _________ from the member. The 2 HIPAA verifiers must be provided by
the _________, not the caller.
Verbal authorization/ member
In Omni the intent/tasks that are used to update demographics
(address,name,DOB) require the user to first access _________ system to verify
what information it has.
MARx
When a member has other insurance besides Centene's, this is referred to as:
OHI or COB
___________ Grievances require a written response but __________ Grievances
are handled by the CSR AND USUALLY resolved within first call.
