Centene Midterm 50 questions with complete solutions already passed!!

Centene Midterm 50 questions with complete solutions already passed!! How long can member be out of their area without being disenrolled? Over 6 months 1 year Less than 6 months 8 months Less than 6 months Who is the Medicare Part B monthly premium paid to? CMS The member Private insurance company CMS How does a member request to sign up for an Optional Supplemental Benefits package? Call and speak with the Sales Department Online through the Member Service Portal Request to meet with a Broker in person Mail in the Optional Benefits Individual Enrollment Form Mail in the Optional Benefits Individual Enrollment Form An example of Concierge Customer Service would be anticipating a member's needs and going out of your way to minimize a caller's effort. True False True Which of the following actions would require you to leave a note within the intent? (Pick 2) If you had to make an outgoing call If the intent captures all relevant information If you had to locate information outside of Omni You must include a note in every intent If you had to make an outgoing call If you had to locate information outside of Omni Which intents require the use of a template for the intent-level notes? (Pick 3) Pharmacy claims inquiry issues Medical claims inquiry Medical authorization inquiry Pharmacy authorization inquiry issues Medical authorization inquiry Pharmacy authorization inquiry If you open up the Gaps in Care intent and the member has none open, you would need to make note of that in the Final Call Summary field? True False False When can a DSNP member disenroll? (Pick 2) Annual Enrollment Period one time every month One time every quarter for the first 9 months of the year Anytime they want Twice every month of the year Annual Enrollment Period One time every quarter for the first 9 months of the year CSRs will inform callers of interpreter services being free. True False True How do you document prospective member and CMS test calls in Omni? Other action > Exit interaction Other action > Member not found > Benefits & Eligibility inquiry Other action > Member not found > Log view status No note is needed Other action > Member not found > Log view status The following items may be used for HIPPA verification except: Member name email Last 4 SSN Member date of birth Member ID number email It is permissible in some situations to provide medical advice to members. True False False When quoting PPO benefits to a member, you should quote both ____ and ____ benefits and cost shares? (Pick 2) In-Network Non-Covered Out of Network Covered In-Network Out of Network Transportation, Over the Counter, and Gym membership are examples of _________ _________. None of the ones mentioned Supplemental Benefits rewards Program Contest Prizes Supplemental Benefits Plan benefits can vary from plan to plan / state to state. True False True Which of the following are true about HIPAA? (Pick 3) Complaints about breaches must be tracked and investigated All PHI should be kept confidential Piggy-Backing is not a HIPAA violation Access to PHI is based on a "need to know" basis Piggy-Backing is not a HIPAA violation When a member leaves the plan and then a few months later returns to the plan, this is referred to as _________________. Reinstatement Reregistration Re-Initiation Reenrollment Reenrollment Members that are on a Medicare Advantage Plan can also have a Medigap plan? True False False Centene has DSNP plans. What does this typ of plan mean? Plans which a member must have both Medicare & Medicaid Plans that offer only dental and vision coverage Plans that offer both health and life insurance Plans in which a spouse must be covered under the same plan Plans which a member must have both Medicare & Medicaid The three government sponsored plans Centene participates in are: (Pick 3) Medicare Marketplace Medicaid Commercial Medicare Marketplace Medicaid The following are types of Medicare Advantage Plans that Centene offers. (Pick 5) DSNP HMO FFS PPO CSNP MAPD DSNP HMO PPO CSNP