WELLCARE EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS
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: - Answera.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. - Answer60
An LEP is assessed by CMS when a member goes___days or longer
without creditable prescription drug
coverage after they become Medicare-eligible. - AnswerB. 63 DAYS
Ascend is a fast, easy, and compliant way for brokers/agents to submit
agent-assisted electronic
enrollments. - AnswerTRUE
A Health Risk Assessment (HRA): - Answera. 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. -
AnswerTRUE
A broker/ agent who has never had any verbal warnings cannot be issued
a corrective action plan. - AnswerFALSE
A Low-income subsidy (LIS) member will be assigned of the __copay
categories depending on the level of need. - AnswerC. FOUR
All prescription drug plans (PDPs) will feature a $0 Tier 1 benefit when
filled at preferred pharmacies. - AnswerTRUE
All prescription drug plans (PDPs) will continue to offer $0 Tier 1
preferred cost-sharing through Express Scripts pharmacy (mail order). -
AnswerTRUE
All Prescription Drug Plans (PDPs) will offer a $__ copay for most Part
D preventive Vaccines, regardless of which network pharmacy is used
by members. - AnswerZERO
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: - Answera.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. - Answer60
An LEP is assessed by CMS when a member goes___days or longer
without creditable prescription drug
coverage after they become Medicare-eligible. - AnswerB. 63 DAYS
Ascend is a fast, easy, and compliant way for brokers/agents to submit
agent-assisted electronic
enrollments. - AnswerTRUE
A Health Risk Assessment (HRA): - Answera. 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. -
AnswerTRUE
A broker/ agent who has never had any verbal warnings cannot be issued
a corrective action plan. - AnswerFALSE
A Low-income subsidy (LIS) member will be assigned of the __copay
categories depending on the level of need. - AnswerC. FOUR
All prescription drug plans (PDPs) will feature a $0 Tier 1 benefit when
filled at preferred pharmacies. - AnswerTRUE
All prescription drug plans (PDPs) will continue to offer $0 Tier 1
preferred cost-sharing through Express Scripts pharmacy (mail order). -
AnswerTRUE
All Prescription Drug Plans (PDPs) will offer a $__ copay for most Part
D preventive Vaccines, regardless of which network pharmacy is used
by members. - AnswerZERO
