2023 Wellcare ACT Mastery Certification Answered

By selecting the correct provider during the enrollment process, you can: - ANSWER All of the above A grievance request, or any evidence concerning a grievance, must be fi led orally or in writing no later than _____ ...

By selecting the correct provider during the enrollment process, you can: - ANSWER All of the above A grievance request, or any evidence concerning a grievance, must be fi led 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. - ANSWER 60 The Single Sign-On Portal provides access to several applications, including Centene Workbench. - ANSWER True Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation. - ANSWER True Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a: - ANSWER -Complaint Tracking Module (CTM) -Grievance -Secret Shop Finding The NEW online Centene Workbench self-service portal enables you to: - ANSWER All of the above When discussing prescription drug coverage, you should: - ANSWER -Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). -Confirm coverage of the beneficiary's current and/or anticipated prescriptions. -Explain formulary tiers as well as drug copayment amounts. -For drugs that are not covered by the new plan, explain the Transition Fill program and how to request a coverage exception. Once the enrollment is completed, you can save a copy of the application for your reference. - ANSWER False A Health Risk Assessment (HRA) can be completed for C-SNP and D-SNP plans only, before the enrollment application process in Ascend through the Value Based Enrollment (VBE) portal. - ANSWER False Which resources are available for download from the Shared Resources section found within Centene Workbench? - ANSWER All of the above During an appointment, you may not discuss any products not agreed to in advance by the beneficiary. - ANSWER True A broker/agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information. - ANSWER True A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. - ANSWER False Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. - ANSWER False When a paper SOA form is used, it must be completed __________ hosting the sales presentation. - ANSWER Prior to Prior to completing the enrollment form, you should always confirm the beneficiary's primary care physician (PCP) and/or specialists. - ANSWER True Which of the following statements about Scope of Appointment (SOA) is FALSE? - ANSWER An electronic SOA submitted in Ascend must be in a Pending status prior to beginning the appointment. The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). - ANSWER True Centene's 2023 product expansion represents a __% increase from 2022. - ANSWER 3 For 2023, Ascension Complete added 27 new counties to their footprint. - ANSWER True For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions. - ANSWER Value Plus Wellcare added ___ counties to their footprint for 2023. - ANSWER 209 The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on all Value Script, Value Plus PDPs, and select Wellcare MAPD plans. - ANSWER True ____ PDPs will be offered across all 50 U.S. states and Washington, D.C. - ANSWER Three Which standalone Prescription Drug Plan is best for a dual-eligible chooser? - ANSWER Classic All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies. - ANSWER True All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order). - ANSWER True The _________ plan is expected to have one of the lowest premiums in the country! - ANSWER Value Script There are ___ LIS copay categories that could be assigned to a member, depending on the level of need. - ANSWER four Centene has new PPO D-SNP product expansion in CT, IN, KS, KY, MS, OH, OK, PA, SC, and a new HMO D-SNP in LA. - ANSWER True What are some examples of steps that can be taken when safeguarding and securing PHI and PII? - ANSWER -Shred documents that contain PHI or PII using appropriate means. -Never leave laptops, PHI, or PII in an unattended vehicle. -Do not include PHI or PII in the subject line or body of an email. -Secure emails that contain PHI or PII. A Health Risk Assessment (HRA): - ANSWER All of the above Wellcare offers a range of Medicare plans to provide members with affordable access to: - ANSWER All of the above Which option is the preferred method to submit enrollment? - ANSWER Ascend Web/Mobile Application What are some examples of what can trigger a beneficiary complaint? - ANSWER -Did not consent to enroll in the plan. -Received incorrect plan benefit information or were dissatisfied with plan benefits. -Had enrollment/disenrollment issues (e.g., disenrollment/cancellation requests, late enrollment penalty, loss of entitlement). -Were misled about which providers were in-network. Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task. - ANSWER True ______ events are designed to inform the people that attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. - ANSWER Educational Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. - ANSWER True Which of the following is not an example of Protected Health Information (PHI)? - ANSWER Library card Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. - ANSWER True Brokers/Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare Products. - ANSWER True 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