Centene- Medicare--Final Review Questions With Correct Answers Already Passed!!

Centene- Medicare--Final Review Questions With Correct Answers Already Passed!! All calls that are from providers are immediately transferred to Provider Service after Properly documenting in Omni a)True b)False True What is the correct intent for scheduling transportation? a) Log View Statue b) Accumulator inquiry c) Issues d) Billing a) Log View Statue Opioid Treatment Program Services is part of Medicare Part C a)True b)False b)False You should offer cover determination - Tier Exception for the following Scenario: What do you offer? "My doctor recently prescribed me a medication that the pharmacy is telling me has a copay. I can't afford that! Am I just supposed to go out the medicine my doctor says I need? a)True b)False a)True Match with the correct States below: a) Fax the CM referral form to b) Send a secure detailed email c) Call and leave a detailed message on CM line or send a secure detailed email 1.__________ Arizona 2._________ California 3._________ Oregon 1. C Arizona 2. A California 3. B Oregon Change payment method intent is used: a) Used to schedule transportation b) Used to add, remove, or modify credit card information to automatically pay a premium. c) Used to request authorization d) Used to add AOR b) Used to add, remove, or modify credit card information to automatically pay a premium. TAT for the prior Authorization request for urgent requests a) 24-36 hours b) Same day c) 5 business days d) 24-72 hours d) 24-72 hours All of the Centene HealthNet and All Well have plans that are PPOs a) True b) False b)False You must not document via Member not found if the member was not located in Omni? a) True b) False b)False "I feel depress and worthless' is an example of Behavior Health Crisis Calls a) True b) False a)True "I think it would be the best for everyone if I was around anymore" is an example of Behavior Health Crisis Calls a) True b) False a)True You can verify Member's Eligibility in Portico a) True b) False b)False World-wide coverage is offered by all Centene plans a) True b) False b)False If address that reflects in MARx is different than the one in Omni we would a) Apologize for the inconvenience and ask them to contact SSA to make the address change b) Submit the address change request c) Send an update address request via Log View Status to Misc enrollment issues. d) Submit the address change request and direct the member to contact the social Security Admin to update their address with them d) Submit the address change request and direct the member to contact the social Security Admin to update their address with them I cannot talk to a member with TTY operator on the line because it is a violation of HIPAA a) True b) False b) False When making a permanent address and the member will be put of the coverage area, we should offer to transfer to Sales a) True b) False b) False Which Omni intent would you use when / if a member calls in to ask how much of their deductible has been met? a) Billing and payment b) issues c) Accumulator inquiry d) Benefits & Eligibility c) Accumulator inquiry When a call comes in and no one answers the phone, it is safe to not document it because the call does not record a) True b) False b) False a) Used to verify if a Care Manager / Case Manager is assigned to a member b) Used to add, remove, modify credit card c) Intent used to verify if deductible has been met d) Intent to to update a member's language, ethnicity, and email address e) Intent used to document a request for a Coverage Determination 1.__________ Change payment method 2._________Pharmacy Authorization Inquiry 3._________ Accumulator inquiry 4._________Update member preferences 5._________ Care Management 1. e Change payment method 2. a Pharmacy Authorization Inquiry 3. c Accumulator inquiry 4. d Update member preferences 5. b Care Management You can offer a member ___________ if they have long-term maintenance medications (such as high blood pressure medications) and the member expresses difficulty getting to the pharmacy every month. a) Transportation b) Mail order c) Medical advice b) Mail order Premium payments apply for both the MOOP and the TROOP a) True b) False b) False All of the following EXCEPT for one that allows a MAPD member to disenroll a) Open Enrollment Period