Wellcare 2023

By selecting the correct provider during the enrollment process, you can: a. Increase member satisfaction. b. Ensure timely access to the member's PCP. c. Minimize call volumes/complaints. d. All of the above

All the above

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. All of the above

All the above

Which standalone Prescription Drug Plan is best for a dual-eligible chooser? a. Value Script b. Value Plus c. Classic

Classic

Agents may be investigated after being suspected of noncompliant activity reported through a: (Select all that apply.) a. Complaint Tracking Module (CTM) b. Yelp Review c. Grievance d. Secret Shop Finding

Complaint Tracking Module (CTM), Grievance, Secret Shop Finding

What are some examples of what can trigger a beneficiary complaint? (Select all that apply.) a. Did not consent to enroll in the plan. b. Received incorrect plan benefit information or were dissatisfied with plan benefits. c. Had enrollment/disenrollment issues (e.g., disenrollment/cancellation requests, late enrollment penalty, loss of entitlement). d. Were misled about which providers were in-network.

Did not consent to enroll in the plan, Received incorrect plan benefit information or were dissatisfied with plan benefits, Were misled about which providers were in-network

An agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. Select one: True False

False

Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. Select one: True False

False

Once the enrollment is completed, you can save a copy of the application for your reference. Select one: True False

False

Verbal permission granted to discuss plan details qualifies an authorized representative to complete an application on behalf of the beneficiary. Select one: True False

False

When completing an application, you should ensure that you enter the provider ID of a specialist and not a primary care physician (PCP). Select one: True False

False

There are ___ LIS copay categories that could be assigned to a member, depending on the level of need. a. two b. three c. four d. five

Four

Which of the following is not an example of Protected Health Information (PHI)? a. Medical records b. Payment history c. Library card

Library card

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? a. Member Service b. Reputation c. Member Payments d. Serving Government Customers

Member Payments

____ PDPs will be offered across all 50 U.S. states and Washington, D.C. a. Two b. Three c. Four d. Five

Three

All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order). Select one: True False

True

All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies. Select one: True False

True

Centene requires all contracted agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. Select one: True False

True

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. Select one: True False

True

Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. Select one: True False

True

The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on all Value Script, Value Plus PDPs, and select Wellcare MAPD plans. Select one: True False

True

The Wellcare preferred pharmacy network includes Walgreens, CVS, and many grocery chains in 2023. Select one: True False

True

To ensure accurate data entry, you should repeat the Medicare ID back to the beneficiary. Select one: True False

True

For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3 and tier 6 prescriptions. a. Classic b. Value Plus c. Value Script

Value Plus

The _________ plan is expected to have one of the lowest premiums in the country! a. Classic b. Value Plus c. Value Script

Value Script

Communication of PHI can be: (Select all that apply.) a. Written b. Electronic c. Verbal

Written, Electronic, Verbal

Wellcare added ___ counties to their footprint for 2023. a. 122 b. 209 c. 284 d. 327

209

Centene's 2023 product expansion represents a __% increase from 2022. a. 1 b. 2 c. 3 d. 5

3

Value Script and Value Plus PDP products have a ___-tier formulary structure for 2023. a. 3 b. 4 c. 5 d. 6

6

Key areas you as an agent have control over and impact upon regarding Star Ratings for quality are: a. Member Satisfaction/Experience b. Complaints c. Rapid Disenrollment d. All of the above

All of the above

The information contained within ACT will equip agents to certify, market, and sell which health plans? a. Ascension Complete b. Wellcare c. All of the above

All of the above