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Exam (elaborations)

Wellcare Exam 2024 questions and answers correct verified 100%

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2024/2025 Written for academic year
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Course Wellcare Insurance
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Wellcare Exam 2024 questions and answers correct verified 100%Wellcare Exam 2024 questions and answers correct verified 100% A request to the plan to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (medicare) is a/an: - correct answers-a.APPEAL A grievance request, or any evidence concerning a grievance, must be filed 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. - correct answers-60 An LEP is assessed by CMS when a member goes___days or longer without creditable prescription drug coverage after they become Medicare-eligible. - correct answers-B. 63 DAYS Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments. - correct answers-TRUE A Health Risk Assessment (HRA): - correct answers-a. Provides physiscians with an overview of a member's health status. B. help us understand the unique health situation og each of our members and allows us to make sure they receive the services that meet their needs. c. is an important part of our quality initiative, directly impacting our star ratings. D. ALL OF THESE (CORRECT) A broker/agent may be terminated for cause if they fail to comply with compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful complete information. - correct answers-TRUE A broker/ agent who has never had any verbal warnings cannot be issued a corrective action plan. - correct answers-FALSE A Low-income subsidy (LIS) member will be assigned of the __copay categories depending on the level of need. - correct answers-C. FOUR All prescription drug plans (PDPs) will feature a $0 Tier 1 benefit when filled at preferred pharmacies. - correct answers-TRUE All prescription drug plans (

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Wellcare Exam 2024 questions and answe
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AlkrequestlktolkthelkplanlktolkthelkplanlkfromlkalkmemberlkorlkproviderlkforlkalkformallkreviewlkoflkanlkActionlk(Denial
)lkorlk

AdverselkPlanlkDeterminationlk(medicare)lkislka/an:lk-lkcorrectlkanswers-a.APPEAL

Alkgrievancelkrequest,lkorlkanylkevidencelkconcerninglkalkgrievance,lkmustlkbelkfiledlkorallylkorlkinlkwritinglknolklate
rlkthanlk__lkcalendarlkdayslkfromlkthelkdatelkoflkthelkeventlkorlkthelkdatelkthelkmemberlkislkmadelkawarelkoflkthelkiss
ue.lk-lkcorrectlkanswers-60

AnlkLEPlkislkassessedlkbylkCMSlkwhenlkalkmemberlkgoes___dayslkorlklongerlkwithoutlkcreditablelkprescriptionlkdr
uglk

coveragelkafterlktheylkbecomelkMedicare-eligible.lk-lkcorrectlkanswers-B.lk63lkDAYS

Ascendlkislkalkfast,lkeasy,lkandlkcompliantlkwaylkforlkbrokers/agentslktolksubmitlkagent-assistedlkelectroniclk

enrollments.lk-lkcorrectlkanswers-TRUE

AlkHealthlkRisklkAssessmentlk(HRA):lk-lkcorrectlkanswers-
a.lkProvideslkphysiscianslkwithlkanlkoverviewlkoflkalkmember'slkhealthlkstatus.lk

B.lkhelplkuslkunderstandlkthelk

uniquelkhealthlksituationlkoglkeachlkoflkourlkmemberslkandlkallowslkuslktolkmakelksurelktheylkreceivelkthelk

serviceslkthatlkmeetlktheirlkneeds.

c.lkislkanlkimportantlkpartlkoflkourlkqualitylkinitiative,lkdirectlylk

impactinglkourlkstarlkratings.lk

D.lkALLlkOFlkTHESElk(CORRECT)

Alkbroker/agentlkmaylkbelkterminatedlkforlkcauselkiflktheylkfaillktolkcomplylkwithlkcompliancelkinvestigation,lkenco
uragelkotherslktolkavoidlkthelkcompliancelkinterviewlkprocess,lkorlkfaillktolkprovidelktruthfullkcompletelkinformati
on.lk-lkcorrectlkanswers-TRUE

Alkbroker/lkagentlkwholkhaslkneverlkhadlkanylkverballkwarningslkcannotlkbelkissuedlkalkcorrectivelkactionlkplan.lk-
lkcorrectlkanswers-FALSE



AlkLow-
incomelksubsidylk(LIS)lkmemberlkwilllkbelkassignedlkoflkthelk__copaylkcategorieslkdependinglkonlkthelklevellkoflkne
ed.lk-lkcorrectlkanswers-C.lkFOUR

, Alllkprescriptionlkdruglkplanslk(PDPs)lkwilllkfeaturelkalk$0lkTierlk1lkbenefitlkwhenlkfilledlkatlkpreferredlkpharmacies.lk
-lkcorrectlkanswers-TRUE

Alllkprescriptionlkdruglkplanslk(PDPs)lkwilllkcontinuelktolkofferlk$0lkTierlk1lkpreferredlkcost-
sharinglkthroughlkExpresslkScriptslkpharmacylk(maillkorder).lk-lkcorrectlkanswers-TRUE

AlllkPrescriptionlkDruglkPlanslk(PDPs)lkwilllkofferlkalk$__lkcopaylkforlkmostlkPartlkDlkpreventivelkVaccines,lkregardle
sslkoflkwhichlknetworklkpharmacylkislkusedlkbylkmembers.lk-lkcorrectlkanswers-ZERO

Atlkthelkendlkoflkthislkcourse,lktherelkwilllkbelkalkMasterylkExam.lkAgentslkmustlkachievelkalkpassinglkscorelkoflk85%lk
orlkhigherlktolksuccessfullylkcompletelkthislkcourse.lk-lkcorrectlkanswers-TRUE

AlthoughlkoptionslkforlkcapturinglkandlksubmittinglkSOAslkvarylkbylkhealthlkplan,lkwellcarelkacceptslkSOAslkinlkwhi
chlkoflkthelkfollowinglkmethods?lk-lkcorrectlkanswers-ALLlkOFlkTHESE

AnylkrequestlkorlkdistributionlkoflkPHlkshouldlkcontainlkonlylkthelkminimumlkamountlkoflkPHlkrequiredlktolkcomple
telkthelkintendedlktasklk-lkcorrectlkanswers-TRUE

AnlkSEPlkislkalkperiodlkoutsidelkoflkthelkICEP,lkAEP,lkorlkMAlkOEPlkwhenlkbeneficiarieslkcanlkenrolllkbasedlksolelylkonlk
lifelkeventslkthatlkqualifylkforlkanlkSEPlkperiod.lk-lkcorrectlkanswers-TRUE

Beneficiary-
facinglkmarketinglkmaterialslkforlkmultiplelkMAlkorganizationslkorlkplanslkmustlkbelksubmittedlktolkthelkHPMSlkMa
rketinglkModulelkbylkthelkthird-partylkmarketinglkorganizationlk(TPMO)lknolklaterlkthanlk30lkdayslkoflkuse.lk-
lkcorrectlkanswers-FALSE



Broker/AgentslkcanlksubmitlkalksupportlkticketlkonlinelkthroughlktheirlkCentenelkWorkbenchlkportallk-
lkcorrectlkanswers-TRUE



Brokers/agentslkmaylkbelkinvestigatedlkafterlkbeinglksuspectedlkoflknoncompliantlkactivitylkreportedlkthroughlka
:lk-lkcorrectlkanswers-a.lkCompliantlktrackinglkmodulelk(CTM)lk

b.lkGrievancelk

c.lksecretlkshoplkfinding.

Broker/AgentslkcanlkaccesslkthelkfollowinglkresourceslkunderlkthelkSharedlkResourceslksectionlkinlkCentenelkWor
kbenchlk-lkcorrectlkanswers-ALLlkOFlkTHESE

Broker/AgentslkcanlkaccesslkandlkdownloadlkenrollmentlkmaterialslkthroughlkCustomPoint.lk-
lkcorrectlkanswers-TRUE



Broker/AgentslkMUSTlkcompletelkalkWellcarelkcontractlkrecertificationlkcaselkinlkCentenelkWorkbenchlk(CWB)lke
verylktwolkyears.lk-lkcorrectlkanswers-FALSE

Centenelkrequireslkalllkcontractedlkbrokers/agentslktolkread,lkunderstand,lkandlkagreelktolkCentene'slkBusinesslk
EthicslkandlkCodelkoflkConductlkPolicylk-lkcorrectlkanswers-TRUE

CustomPointlksaleslkmateriallkorderlkdateslkwilllkbelkpostedlkonlkWellcare.comlk-lkcorrectlkanswers-FALSE

CVSlkCaremarklkMaillkOrderlkwilllkbelkin-networklkforlk2024.lk-lkcorrectlkanswers-FALSE

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