Provider Core New Hire Assessement 1: Question Preview (ID: 25980)

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Which department is responsible for loading and configuring provider contracts?
a) Contracts
b) Configuration
c) Communications
d) Credentialing

Which department is responsible to assist providers with prior authorizations?
a) Health Services
b) Customer Service
c) Provider Resolutons
d) Credentialing

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) Authorization Codes
c) Types of Service Codes
d) CPT Codes

Where on WellCare Link would you find timeframes on ID Cards?
a) Document Changes
b) Quick Hits
c) Helpful Links
d) Support Department

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) Advantage Participant
b) Special Grouping
c) Dual Eligible
d) Co-eligible

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

What term best describes the ability to identify with, understand, and appreciate another person's feelings, motives, desires, and situation?
a) Sympathy
b) Emotional Intelligence
c) Taking Ownership
d) Empathy

What does the PCP use to request a referral?
a) Referral Form or Script
b) Referral Form, Script, or COB
c) Referral Form, Script, or WellCare Website
d) Referral Form, COB, Sript, or WellCare Website

What is the name of the process used to evaluate the qualifications and credentials of providers?
a) Communications
b) Contracting
c) Configuring
d) Credentialing

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) Material Request
b) Eligibility Status
c) Authorizations Status
d) ID Card Request

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) Exactus Pharmacy Solutions
b) Pharmacy Services
c) Health Services Authorizations
d) Claims Authorizations

Eligibility for Medicaid is usually based on the family or individual’s _____________.
a) Income
b) Health
c) Insurance
d) Age

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.

Dr. Hemingway calls and you cannot locate him using basic and advanced searches in CAREConnects. What action would you take next?
a) Transfer the call to the Provider Resolution Team.
b) Select the Non-Par Provider button and enter the provider's information manually.
c) Transfer the call to your supervisor.
d) Select the Provider Not Found button, proceed with the call, but enter all the provider's information in the notes.

Considering the provider experience model, which of the following interactions are in the right order
a) Credentialing, Provider Relations, Configuration
b) Provider Communications, Customer Service, Provider Sees New Patients
c) Health Services, Customer Service, Provider Communications
d) Configuration, Provider Communications, Credentialing

Which of the following is not a way to show empathy to a customer?
a) Concentrate on understanding the Member’s viewpoint. Give the member your undivided attention. Avoid distractions.
b) Confirm your listening effectiveness by using appropriate verification statements.
c) Establish a positive first impression.
d) Show the Member that you are looking at things from their perspective. Use reassuring responses such as, “I see what you mean

Which of the following is an Inpatient Authorization type?
a) OBS
b) INQ
c) SUR
d) PRI

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

A Customer Service Representative must log calls received from ____________?
a) Members
b) Providers
c) Vendors
d) All callers

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 MET
c) Caller Requests Further Assistance
d) Escalate to Supervisor

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