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IA Medicaid New Hire Assessment 2
Test Description: N/a
Instructions: Answer all questions to get your test result.
1) A member calls Customer Service to ask benefit questions. During the conversation, the member mentions they haven't had an appetite lately because they are depressed. How would you handle the call?
A
Assist the member with their inquiry and disregard the comment made about weight loss
B
Refer the member to their doctor to assist
C
Transfer the member to Behavioral Health
2) A member calls Customer Service upset about WellCare denying her doctor’s authorization request for bariatric surgery. She wants us to reconsider our decision. What would this be considered?
A
None apply
B
Appeal
C
Complaint
D
Grievance
3) A member calls with questions about hearing aid benefits. Which CAREConnects call driver would you select to assist the member?
A
Hearing Benefit Inquiry
B
Materials Request Caid
C
Benefits Inquiry
D
Hearing Materials Caid
4) An Iowa member can call the 24 hour nurse advice line for help related to which of the following:
A
Help with dizziness or feeling sick to their stomach
B
ID card
C
Transportation to PCP Office
5) As a Customer Service Representative (CSR), you are required to complete verification before providing any account specific information.
A
True
B
False
6) As a Customer Service Representative, you are required to check the system to determine if the caller has legal authorization to act on behalf of a Member.
A
False
B
True
7) Bob is calling to change his PCP. He does not qualify for an exception but he still wants his PCP changed. Today is the 12th of August. What day will the PCP change take effect?
A
August 12th
B
September 1
C
August 30th
D
August 31st
8) Frank is calling to change his wife’s PCP for her. In order to change the PCP, what must Frank be listed as on his wife’s account?
A
Legal Guardian
B
POA
C
He doesn’t need to be listed. He can make the change because they are married.
D
POA or Legal Guardian
9) Iowa Medicaid State Eligibility portal is an online application WellCare uses to view Iowa Medicaid eligibility for Members and Providers.
A
True
B
False
10) Members are able to file a grievance by mail, fax or phone.
A
False
B
True
11) Mr. Edwards just received his ID card. He is not happy with the PCP listed on his ID card. What is the primary call driver you will choose in CAREConnects?
A
Update ID Card
B
PCP Change
C
ID Card Change
D
Update PCP
12) Mr. Porter is calling to order a new ID card for his wife Jenna. Which Caller Type should be selected in CAREConnects?
A
Third Party
B
Ancillary
C
Broker
D
Member
13) Ms. Clark calls WellCare Customer Service. She is expecting her first child and was recently laid off from her job. She previously had medical insurance through her employer. What will you tell her?
A
Explain all the enhanced benefits offered by the WellCare Medicaid plan
B
Refer her to Healthy Connections Choices
C
Refer her to local Medicaid office
D
Ask her to call back again during the annual enrollment period
14) Ms. Taylor calls WellCare. She has recently enrolled in the Iowa Medicaid plan and has not received her ID card yet. What call driver would you select in CAREConnects?
A
Address Change Caid
B
Materials Request Caid
C
Member Materials Caid
D
ID Card Request
15) The CMS Appointment of Representative (AOR) form is also known as what?
A
CMS 2013
B
CMS 1696
C
CMS 1500
D
CMS 04
16) What call driver should be used when submitting a request to have a Portuguese translator present for a member’s doctor appointment?
A
Member Validation
B
Other
C
Benefits Inquiry
D
PCP Change
17) What do you do when a member’s account shows as having other insurance (coordination of benefits) but they indicate that is not valid?
A
Submit a request to your supervisor to have the member’s information updated.
B
Advise the member to contact the insurance company to have them send in a letter.
C
Contact the insurance company we have listed and validate the information.
D
Submit a request in CAREConnects to have someone validate the insurance information.
18) What is the timeframe for WellCare to respond to an expedited appeal request from an Iowa member?
A
5 business days
B
48 hours
C
3 business days
D
1 business day
19) Which of the following information is NOT included on the Member's ID card?
A
Member Social Security Number
B
Member ID Number
C
PCP Name
D
PCP Phone Number
20) Which of the following is a standard Customer service call opening?
A
Thank you for calling WellCare. May I have the Member's ID Number please?
B
Thank you for calling WellCare of Iowa Customer Service. May I have the Member's ID Number please?
C
Thank you for calling Customer Service. May I have the Member's ID Number please?
D
Thank you for calling Iowa Medicaid. May I have the Member's ID Number please?
*select an answer for all questions
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