Level 2 Review
Quiz by Ashley Jones
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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
30s - 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
30s - Q3
MA-OEP NEW happens annually from January 1st to March 31st.
falsetrueTrue or False30s - Q4
Change in residence, loss of Medicaid, and gaining LIS are all examples of which enrollment period?
ICEP
LMNOP
SEP
AEP
30s - Q5
The ICEP election period lasts a total of _____ months.
6
4
3
7
30s - 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
30s - 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 June 1
Exception PCP Change; effectiveMay 28
Retroactive PCP Change; effective May 1
30s - 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.
30s - 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.
30s - 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
30s - 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.
falsetrueTrue or False30s - Q12
Match the timeframes.
Users link answersLinking60s - 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.
30s - Q14
A "Duplicate Therapy" rejection displays as ________ in both RxNova and PA Hub.
047
PAC
DT
prior authorization
30s - Q15
Formulary Exception EOCs can ONLY be faxed to the doctor.
truefalseTrue or False30s