Review Game Zone
Flash Cards
(current)
Games
Teachers
Search
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
Providers
B
All callers
C
Vendors
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
Caller is Dissatisfied/Upset
B
Escalate to Supervisor
C
Escalate to MET
D
Caller Requests Further Assistance
3) Considering the provider experience model, which of the following interactions are in the right order
A
Configuration, Provider Communications, Credentialing
B
Provider Communications, Customer Service, Provider Sees New Patients
C
Credentialing, Provider Relations, Configuration
D
Health Services, Customer Service, Provider Communications
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 Non-Par Provider button and enter the provider's information manually.
B
Transfer the call to the Provider Resolution Team.
C
Select the Provider Not Found button, proceed with the call, but enter all the provider's information in the notes.
D
Transfer the call to your supervisor.
5) Eligibility for Medicaid is usually based on the family or individual’s _____________.
A
Insurance
B
Income
C
Health
D
Age
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 pays more.
C
Which insurer has a lower copay.
D
Which insurer has primary responsibility.
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
Pharmacy Services
B
Claims Authorizations
C
Health Services 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
Eligibility Status
B
Authorizations Status
C
Material Request
D
ID Card Request
9) What does the PCP use to request a referral?
A
Referral Form, Script, or COB
B
Referral Form or Script
C
Referral Form, COB, Sript, or WellCare Website
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
Contracting
B
Credentialing
C
Communications
D
Configuring
11) What system will you use if the CAREConnects system is down?
A
Contingency Scripting
B
Downtime Scripting
C
Downtime Call Flow
D
Contingency Call Flow
12) What term best describes the ability to identify with, understand, and appreciate another person's feelings, motives, desires, and situation?
A
Empathy
B
Taking Ownership
C
Emotional Intelligence
D
Sympathy
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
Dual Eligible
B
Advantage Participant
C
Co-eligible
D
Special Grouping
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
Authorization Codes
B
POS Codes
C
CPT Codes
D
Types of Service Codes
15) Where on WellCare Link would you find timeframes on ID Cards?
A
Helpful Links
B
Document Changes
C
Support Department
D
Quick Hits
16) Which department is responsible for loading and configuring provider contracts?
A
Communications
B
Credentialing
C
Configuration
D
Contracts
17) Which department is responsible to assist providers with prior authorizations?
A
Customer Service
B
Provider Resolutons
C
Credentialing
D
Health Services
18) Which of the following features are available using WellCare's IVR system?
A
Verify member's date of birth or home address.
B
Initiate the referral process.
C
Request member eligibility status.
D
Cancel a claim
19) Which of the following is an Inpatient Authorization type?
A
OBS
B
INQ
C
PRI
D
SUR
20) Which of the following is not a way to show empathy to a customer?
A
Establish a positive first impression.
B
Concentrate on understanding the Member’s viewpoint. Give the member your undivided attention. Avoid distractions.
C
Confirm your listening effectiveness by using appropriate verification statements.
D
Show the Member that you are looking at things from their perspective. Use reassuring responses such as, “I see what you mean
*select an answer for all questions
Check Results & Get Answers
Play Games with the Questions Above
Teachers: Create FREE classroom games with your questions
Click for more info!
©2007-2024
ReviewGameZone.com
|
About
|
Privacy
|
Contact
|
Terms
|
Site Map
WAIT! Find what you needed?
×
Still Looking for the Answers?
Have Another Question?
Play a Review Game with These Questions?
Want to Make Your Own Test Like This One?