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Level 2 Review

Quiz by Ashley Jones

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23 questions
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  • Q1

    A member calls in stating they believe their sales agent misled them about their plan when they signed up.  Which part classification would this call be documented under?

    Part C

    Part D

  • Q2

    A member calls in asking how much a new medication their doctor prescribed will cost them.  Which part classification would this call be documented under?

    Part D

    Part C

  • Q3

    MA-OEP NEW happens annually from January 1st to March 31st.

    True or False
  • Q4

    Change in residence, loss of Medicaid, and gaining LIS are all examples of which enrollment period?





  • Q5

    The ICEP election period lasts a total of _____ months.





  • Q6

    A member is able to disenroll from their CarePlus plan in the follow ways EXCEPT:

    Enrolling into another Medicare Advantage plan

    Verbally over the phone

    Mailing a written request to CarePlus 

  • Q7

    Talia calls into CarePlus on May 28th asking to change her PCP to a new doctor.  She mentions that she is not due for her next annual wellness appointment until September.  What action will you complete for the member?

    Standard PCP Change; effective September 1

    Standard PCP Change; effective July 1

    Exception PCP Change; effective June 1

    Retroactive PCP Change; effective May 1

  • Q8

    When submitting a Retroactive PCP Change, the ICR must contact the PCP to verify:

    the member has not been seen in the office this month, nor have they filled any prescriptions.

    the member has not requested any org determinations for upcoming procedures.

    the member has not been seen in the office this month, nor have they been hospitalized.

    the member has not been admitted to the hospital, nor filled any prescriptions.

  • Q9

    An example of an Access Grievance would be:

    a member calling in upset that they weren't able to have their copay waived for a follow up appointment.

    a member expressing dissatisfaction when trying to create a password for the MyCarePlus member portal.

    a member expressing frustration with their doctor not providing them a referral for physical therapy.

  • Q10

    A member calls with some questions about a letter he received from CarePlus.  He said the letter shows a list of visits to a chiropractor in town, but he has never been to a chiropractor in his life. You will take all steps listed below to assist the member EXCEPT:

    File a Fraud, Waste, and Abuse grievance

    Verify CarePlus received and paid for the claims listed on the EOB

    Contact the chiropractor's office to verify the billed claims

    Offer the member appeal rights to dispute the claims listed on the EOB

  • Q11

    A member's medication was denied last week as the doctor's notes did not show the member has tried the necessary medications in the step therapy first.  Since the claim has already been clinically denied, we are able to start a new EOC on the member's behalf.

    True or False
  • Q12

    Match the timeframes.

    Users link answers
  • Q13

    Shirley is on a fixed income. She calls CarePlus after learning she has been denied to receive Extra Help for her medication copays.  Shirley tells you she was happy to learn her authorization request for CarePlus to cover her Cosentyx was approved, but she doesn't know how she will afford to pay the copay. How can you assist Shirley?

    Contact her provider's office to discuss switching her medication to something cheaper.

    File a Tier Exception request to reduce Shirley's out of pocket cost.

    Transfer Shirley to Social Services to see if there are any government programs to offset her cost.

    Process an EOC for a prior authorization Coverage Determination.

  • Q14

    A "Duplicate Therapy" rejection displays as ________ in both RxNova and PA Hub.




    prior authorization

  • Q15

    Formulary Exception EOCs can ONLY be faxed to the doctor.

    True or False

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