WELLCARE ACT MASTERY EXAM QUESTIONS &
ANSWERS
Communication of PHI can be:
a.
Written
b.
Electronic
c.
Verbal
A, B and C
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll
based solely on life events that qualify for an SEP period.
True
An agent who has never had any verbal warnings cannot be issued a Corrective Action
Plan.
False
Which of the following is not considered a grievance?
A dispute of the appeal of an organization determination, coverage determination, or a
Late Enrollment Penalty (LEP) determination.
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D
plan premiums.
False
You can help prevent grievances by:
, a.
Always confirming availability of the beneficiary's primary and specialist providers by
using the provider search tool available on the plan's website.
b.
Always using plan materials to clearly explain plan benefits and cost (including
medications) and check for understanding.
c.
Always confirming a beneficiary's intent to enroll before accepting their enrollment
application.
All
Medicare Star Ratings and performance are at the forefront of Wellcare's quality
strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a
Wellcare quality driver?
Member Payments
Which is an example of a top beneficiary complaint that affects Star Ratings?
The beneficiary did not understand that enrolling in a Wellcare plan would change their
current Medicare Advantage plan.
What are some examples of steps that can be taken when safeguarding and securing
PHI and PII?
a.
Shred documents that contain PHI or PII using appropriate means.
b.
Never leave laptops, PHI, or PII in an unattended vehicle.
c.
Do not include PHI or PII in the subject line or body of an email.
d.
Secure emails that contain PHI or PII.
When explaining the provider network for D-SNPs and C-SNPs:
a.
Avoid submitting applications with no primary care provider (PCP) to assist these
higher-risk members.
b.
If a member is not connected to a primary care provider (PCP), we should always
encourage and assist with connecting them with an in-network doctor.
The Mastery Exam will lock for a period of 48 hours after each failed attempt.
ANSWERS
Communication of PHI can be:
a.
Written
b.
Electronic
c.
Verbal
A, B and C
An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll
based solely on life events that qualify for an SEP period.
True
An agent who has never had any verbal warnings cannot be issued a Corrective Action
Plan.
False
Which of the following is not considered a grievance?
A dispute of the appeal of an organization determination, coverage determination, or a
Late Enrollment Penalty (LEP) determination.
Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D
plan premiums.
False
You can help prevent grievances by:
, a.
Always confirming availability of the beneficiary's primary and specialist providers by
using the provider search tool available on the plan's website.
b.
Always using plan materials to clearly explain plan benefits and cost (including
medications) and check for understanding.
c.
Always confirming a beneficiary's intent to enroll before accepting their enrollment
application.
All
Medicare Star Ratings and performance are at the forefront of Wellcare's quality
strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a
Wellcare quality driver?
Member Payments
Which is an example of a top beneficiary complaint that affects Star Ratings?
The beneficiary did not understand that enrolling in a Wellcare plan would change their
current Medicare Advantage plan.
What are some examples of steps that can be taken when safeguarding and securing
PHI and PII?
a.
Shred documents that contain PHI or PII using appropriate means.
b.
Never leave laptops, PHI, or PII in an unattended vehicle.
c.
Do not include PHI or PII in the subject line or body of an email.
d.
Secure emails that contain PHI or PII.
When explaining the provider network for D-SNPs and C-SNPs:
a.
Avoid submitting applications with no primary care provider (PCP) to assist these
higher-risk members.
b.
If a member is not connected to a primary care provider (PCP), we should always
encourage and assist with connecting them with an in-network doctor.
The Mastery Exam will lock for a period of 48 hours after each failed attempt.
