Queenie in 福利

Wellcare grievance request

Agents who have never had any verbal warnings cannot be issued a corrective action plan

A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than 60 calendar days from the date of the event of the date the member is made aware of the issue.

all of the above

Steps to take when safeguarding and securing PHI and PII include:

Wellcare has added ____ new counties to our footprint in 2022

Which of the following is not an example of Protected Health Information (PHI)

All standalone PDP formularies have a ____ -tier structure for 2022

To ensure accurate data entry, you should repeat the Medicare ID back to the beneficiary.

Written, Electronic, Verbal

Communication of PHI can be:

All of the above (Member satisfaction/Experience, Complaints, Rapid Disenrollment)

Key areas you as a Sales Agent/Broker have control over and impact upon regarding Star (quality) ratings are:

All Wellcare standalone PDP plans will have a $0 Tier 1 preferred retail and mail benefit.

Wellcare has expanded coverage in Massachusetts, Nebraska, and Oklahoma.

Wellcare offers a wide variety of Medicare products consolidated under a new Wellcare brand.

Any request of distribution of PHI should contain only the minimum amount of PHI required to complete the intended task.

When completing an application, you should ensure that you enter the provider ID of a specialist and not a Primary Care Physician (PCP).

Must include most of the required elements necessary to complete the enrollment.

Which of the following statements about completing telephonic enrollments is FALSE?

Wellcare has streamlined standalone PDP offerings from six plans to __ in all 34 regions across all 50 states and D.C.

All of the above (Ascension Complete and Wellcare)

The information contained within ACT will equip agents to certify, market and sell which health plans?

Upon completion of the application, you must provide the beneficiary with the enrollment application confirmation ID.

Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing.

Wellcare’s 2022 product expansion represents an 8% increase from 2021

Members in all plans impacted by the 2022 PDP contract consolidation will be reissued an ID card.

All of the above

Agents are to put into practice all guidelines set forth in:

The Agent of Record (AOR) will not remain with the member after the consolidation

Wellcare PDP is consolidating from six plan offerings to three plan offerings for 2022. Identify the INCORRECT statement regarding the plan consolidation.

Verbal permission granted to discuss plan details qualifies an authorized representative to complete an application on behalf of the beneficiary.

Member Payments

Medicare Star Ratings and performance are at the forefront of Wellcare’s quality strategy. Wellcare’s quality focus consists of six drivers. Which of the following is not a Wellcare quality driver?

Complaint Tracking Module (CTM);Grievance;Secret Shop Finding

Agents may be investigated after being suspected of noncompliant activity reported through a:

For 2022, ____ will no longer be a preferred pharmacy.

Wellcare offers a robust portfolio of products and plans across ____ states

The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on the Value Script and Value Plus products.

Health Net; Fidelis Care; Allwell; ‘Ohana; Trillium Advantage; Wellcare

For the 2022 plan year, which health plans will be considered into the Wellcare Medicare brand?

Coverage Gap (Stage 3)

Which stage of coverage is referred to as the “donut hole” as the member is paying the most for drug coverage?

A dispute of the appeal of an organization determination, coverage determination or a Late Enrollment Penalty (LEP) determination.

Which of the following is not considered a grievance?

Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare’s Medicare Products.

All of the above

Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity?

When enrolling a D-SNP beneficiary, be sure to verify plan enrollment eligibility and that the MSP program level is eligible for the requested plan.

a. Value Script
b. Value Plus (not this one)
c. Classic

Which standalone Prescription Drug Plan is best for “dual-eligible” members?

Next Read: Humana - SEP AEP »

This website uses cookies.