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[Show more]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 of the following is not an example of Protected Health Information (PHI)...
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Add to cartMedicare 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 of the following is not an example of Protected Health Information (PHI)...
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 ...
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Add to cartIn 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...
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Add to cartWhich 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...
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Add to cartCOB 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...
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Add to cartFormulary 
 
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...
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Add to cartdeductible 
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...
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Add to cartMedicare 
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 ...
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Add to cartIn 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...
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Add to cartAll 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 
 
...
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Add to cartCEO 
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 ...
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Add to cartA 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...
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Add to cartWhich 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...
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Add to cartA 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...
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Add to cartTrue 
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...
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Add to cartOnce 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...
Agents may be investigated after being suspected of noncompliant activity reported through a Complaint Tracking Module (CTM), 
grievance, secret shop finding, internal audit or reporting. 
True 
 
 
Which of the following health plans are now available through Centene Corporation? Select the best an...
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Add to cartAgents may be investigated after being suspected of noncompliant activity reported through a Complaint Tracking Module (CTM), 
grievance, secret shop finding, internal audit or reporting. 
True 
 
 
Which of the following health plans are now available through Centene Corporation? Select the best an...
During an appointment, you may not discuss any products not agreed to in advance by the beneficiary. 
a. True 
b. False 
True 
 
 
 
When a paper SOA form is used, it must be completed __________ hosting the sales presentation. 
a. Prior to 
b. During 
c. After 
A. Prior to 
 
 
 
Brokers/Agents can...
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Add to cartDuring an appointment, you may not discuss any products not agreed to in advance by the beneficiary. 
a. True 
b. False 
True 
 
 
 
When a paper SOA form is used, it must be completed __________ hosting the sales presentation. 
a. Prior to 
b. During 
c. After 
A. Prior to 
 
 
 
Brokers/Agents can...
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