Wellcare exam stuvia Study guides, Class notes & Summaries

Which of the following is not an example of Protected Health Information (PHI)? - ANSWER-Library card Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. - ANSWER-1 Wellcare must receive notice of an event change or cancellation as soon as possible, but no later than 30 mins after the event start time. - ANSWER-FALSE Ascend is a fast, easy, and compliant way for agents to submit agent-assisted electronic enrollme...

Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. - ANSWER 1 Which elements are available as part of Wellcare's Sales Support model? - ANSWER All of these Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums - ANSWER False Prior to completing the enrollment form, broker/agents should always confirm the beneficiary's primary care provider (PCP) and/or speciali...

A request to the plan to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (medicare) is a/an: - ANSWER a.APPEAL 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. - ANSWER 60 An LEP is assessed by CMS when a member goes___days or longer without creditable prescription drug cove...

With the Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024, existing members can continue to use their current ID card 1/1/2024 and beyond. - ANSWER False - With the PBM migration to Express Scripts effective 1/1/2024, all existing members will receive a new ID card containing new pharmacy processing information and must use their new ID card starting 1/1/2024. Wellcare's _____ plan is designed for Low-Income Subsidy members. Question 29Select one:a. Classic ...

With which types of inquiries can Wellcare's Corporate Sales Support team assist? - ANSWER All of these Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. - ANSWER False A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is a/an: - ANSWER Appeal The Single Sign-On Portal provides access to several applications, including CustomPoint. - ANSWER True...

True - ANSWER-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 - ANSWER-Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? a. Speak with the investigator as quickly as possible. b. Answer all questions honestly and completely. c. Offer information and documents important to the investigation. d. ...

Once the enrollment is completed, you can save a copy of the application for your reference. - ANSWER False When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend after the enrollment application, through the Value-Based Enrollment (VBE) portal. - ANSWER True Which of the following statements about Scope of Appointment (SOA) is FALSE? - ANSWER c. An electronic SOA submitted in Ascend must be in a Pending status ...

Which is an example of a top beneficiary complaint that affects Star Ratings? - ANSWER 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 solely on life events that qualify for an SEP period. - ANSWER True Prior to the beginning of the enrollment process, a broker/agent is required to cover certain beneficiary specific information, ...

When completing an application, you should ensure that you enter the provider ID of a specialist and not a Primary Care Physician (PCP). - ANSWER-False Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. - ANSWER-True Wellcare has streamlined standalone PDP offerings from six plans to a. two plans b. one plan c. three plans d. four plans in all 34 regions across all 50 states and D.C. - ANSWER-c All Wellcare standa...

Selection and Enrollment - ANSWER-Members use ratings systems to help them choose a plan or decide whether to stay with our plans. Reputation - ANSWER-Wellcare strives to be an industry-leading organization that is attractive & valuable to our members and to our providers & government partners. Member Service - ANSWER-Our first priority is to provide our members with excellent care and service. Additional Courses - ANSWER-There will be additional courses offered that are not required fo...