BUNDLE:::::WELLCARE EXAMS

In 2021, Centene is offering which of the the following types of Medicare Advantage Prescription Drug (MAPD) products? A. HMO and HMO/POS B. DSNP and CSNP C. PPO D. PFFS E. All of the above Beneficiaries who are first eligible for Medicare have a seven-month Initial Enrollment Period to ...

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 An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based sol...

COB or primary/secondary issues Utilize the COB inquiries call driver/ Transfer to the pharm help desk if the flow says so, or if the pharmacy message reads 41- submit bill. Controlled Substance edit Edit performs validation check to confirm DEA number listed. Copay inquiry Run a te...

Formulary List of drugs covered by the plan. Usually divided into tiers, the higher the tier the higher the cost share. A medication not listed on the formulary is considered a non-covered medication. Tier 1 - preferred generic. Tier 2- generic. Tier 4 - preferred brand. Tier 4 - non preferred dr...

deductible Amount you must pay before you begin receiving any benefits from your insurance company TERM Medicare DEFINITION A national health insurance program in the United States, begun in 1965 under the Social Security Administration and now administered by the Centers for Medicare and...

Medicare A federal program of health insurance for persons 65 years of age and older Protect Health Information (PHI) Any information about health status, provision of health care, or payment for health care that is created or collected by a Covered Entity (or a Business Associate of a Covere...

In the event you need to use a paper Scope of Appointment (SOA) form, it must be completed____ hosting the sales presentation. Prior to Agents can use the Materials Portal to order sales materials and track shipment True Agents may be terminated for cause if they fail to comply with ...

All calls that are from providers are immediately transferred to Provider Service after Properly documenting in Omni a)True b)False True What is the correct intent for scheduling transportation? a) Log View Statue b) Accumulator inquiry c) Issues d) Billing a) Log View...

CEO Ken Burdick Total Members 4.4 million Provider Network 427,000 Pharmacy Network 68,000 Associates 8,900 Fortune 500 #195 Accomplishment A Fortune Worlds Most Admired Company Medicaid Members 2.7 Million Medicare Members 496,000 ...

A grievance request, or any evidence concerning a grievance, must be filed 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. 60 When completing an application, you should ensure that you enter the provider ID ...

Which of the following is not an example of Protected Health Information (PHI)? Library card Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. 1 Wellcare must receive notice of an event change or cancellatio...

A Health Risk Assessment (HRA) All of the above 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. True Health plan fax numbers vary for health plans that offer fax enrollment submissi...

True Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. True False d. All of the above Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activ...

Once the enrollment is completed, you can save a copy of the application for your reference. False Which elements are available as part of Wellcare's sales support model? All of the above. Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Bu...