IA Medicaid New Hire Assessment 2: Question Preview (ID: 28330)

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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

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) Grievance
b) Appeal
c) Complaint
d) None apply

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) Benefits Inquiry
c) Hearing Materials Caid
d) Materials Request Caid

An Iowa member can call the 24 hour nurse advice line for help related to which of the following:
a) Transportation to PCP Office
b) Help with dizziness or feeling sick to their stomach
c) ID card

As a Customer Service Representative (CSR), you are required to complete verification before providing any account specific information.
a) True
b) False

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) True
b) False

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 30th
b) September 1
c) August 12th
d) August 31st

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) POA
b) Legal Guardian
c) He doesn’t need to be listed. He can make the change because they are married.
d) POA or Legal Guardian

Iowa Medicaid State Eligibility portal is an online application WellCare uses to view Iowa Medicaid eligibility for Members and Providers.
a) True
b) False

Members are able to file a grievance by mail, fax or phone.
a) True
b) False

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) ID Card Change
b) PCP Change
c) Update ID Card
d) Update PCP

Mr. Porter is calling to order a new ID card for his wife Jenna. Which Caller Type should be selected in CAREConnects?
a) Ancillary
b) Third Party
c) Member
d) Broker

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) Refer her to Healthy Connections Choices
b) Refer her to local Medicaid office
c) Explain all the enhanced benefits offered by the WellCare Medicaid plan
d) Ask her to call back again during the annual enrollment period

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) ID Card Request
b) Materials Request Caid
c) Member Materials Caid
d) Address Change Caid

The CMS Appointment of Representative (AOR) form is also known as what?
a) CMS 1696
b) CMS 04
c) CMS 1500
d) CMS 2013

What call driver should be used when submitting a request to have a Portuguese translator present for a member’s doctor appointment?
a) PCP Change
b) Member Validation
c) Benefits Inquiry
d) Other

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) Advise the member to contact the insurance company to have them send in a letter.
b) Submit a request to your supervisor to have the member’s information updated.
c) Submit a request in CAREConnects to have someone validate the insurance information.
d) Contact the insurance company we have listed and validate the information.

What is the timeframe for WellCare to respond to an expedited appeal request from an Iowa member?
a) 1 business day
b) 3 business days
c) 48 hours
d) 5 business days

Which of the following information is NOT included on the Member's ID card?
a) PCP Name
b) PCP Phone Number
c) Member ID Number
d) Member Social Security Number

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 Iowa Medicaid. May I have the Member's ID Number please?
c) Thank you for calling WellCare of Iowa Customer Service. May I have the Member's ID Number please?
d) Thank you for calling Customer Service. May I have the Member's ID Number please?

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