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Provider Core New Hire Assessement 1
Test Description: Provider test Review
Instructions: Answer all questions to get your test result.
1) A Customer Service Representative must log calls received from ____________?
A
Vendors
B
All callers
C
Providers
D
Members
2) At the end of a call, the member is upset or dissatisfied. What button in CAREConnects would you use to escalate the call?
A
Escalate to Supervisor
B
Caller Requests Further Assistance
C
Escalate to MET
D
Caller is Dissatisfied/Upset
3) Considering the provider experience model, which of the following interactions are in the right order
A
Health Services, Customer Service, Provider Communications
B
Configuration, Provider Communications, Credentialing
C
Credentialing, Provider Relations, Configuration
D
Provider Communications, Customer Service, Provider Sees New Patients
4) Dr. Hemingway calls and you cannot locate him using basic and advanced searches in CAREConnects. What action would you take next?
A
Select the Provider Not Found button, proceed with the call, but enter all the provider's information in the notes.
B
Select the Non-Par Provider button and enter the provider's information manually.
C
Transfer the call to your supervisor.
D
Transfer the call to the Provider Resolution Team.
5) Eligibility for Medicaid is usually based on the family or individual’s _____________.
A
Age
B
Income
C
Insurance
D
Health
6) If the member has more than one insurer, what must the provider identify prior submitting a claim to WellCare?
A
If the Authorization Code is the same for the other insurer.
B
Which insurer has primary responsibility.
C
Which insurer has a lower copay.
D
Which insurer pays more.
7) If you are unable to determine if a CPT code needs an authorization using the Auth Look Up Tool, where should you transfer the call?
A
Health Services Authorizations
B
Pharmacy Services
C
Claims Authorizations
D
Exactus Pharmacy Solutions
8) John is calling to request a new ID card. He states that he is new to the plan and has not received an ID card yet. What call driver would you select to assist this Member in CAREconnects?
A
Authorizations Status
B
ID Card Request
C
Eligibility Status
D
Material Request
9) What does the PCP use to request a referral?
A
Referral Form, Script, or COB
B
Referral Form, COB, Sript, or WellCare Website
C
Referral Form or Script
D
Referral Form, Script, or WellCare Website
10) What is the name of the process used to evaluate the qualifications and credentials of providers?
A
Communications
B
Configuring
C
Credentialing
D
Contracting
11) What system will you use if the CAREConnects system is down?
A
Downtime Scripting
B
Downtime Call Flow
C
Contingency Call Flow
D
Contingency Scripting
12) What term best describes the ability to identify with, understand, and appreciate another person's feelings, motives, desires, and situation?
A
Sympathy
B
Empathy
C
Taking Ownership
D
Emotional Intelligence
13) What term is used to describe people who are entitled to Medicare (Part A and/or Part B) and who are also eligible for Medicaid?
A
Special Grouping
B
Co-eligible
C
Dual Eligible
D
Advantage Participant
14) What term is used to describe unique codes assigned to each medical procedure that identifies services performed by physicians and other healthcare providers?
A
POS Codes
B
CPT Codes
C
Authorization Codes
D
Types of Service Codes
15) Where on WellCare Link would you find timeframes on ID Cards?
A
Support Department
B
Quick Hits
C
Document Changes
D
Helpful Links
16) Which department is responsible for loading and configuring provider contracts?
A
Credentialing
B
Contracts
C
Configuration
D
Communications
17) Which department is responsible to assist providers with prior authorizations?
A
Provider Resolutons
B
Credentialing
C
Health Services
D
Customer Service
18) Which of the following features are available using WellCare's IVR system?
A
Initiate the referral process.
B
Cancel a claim
C
Verify member's date of birth or home address.
D
Request member eligibility status.
19) Which of the following is an Inpatient Authorization type?
A
INQ
B
PRI
C
OBS
D
SUR
20) Which of the following is not a way to show empathy to a customer?
A
Confirm your listening effectiveness by using appropriate verification statements.
B
Establish a positive first impression.
C
Show the Member that you are looking at things from their perspective. Use reassuring responses such as, “I see what you mean
D
Concentrate on understanding the Member’s viewpoint. Give the member your undivided attention. Avoid distractions.
*select an answer for all questions
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