Elevance Health Certification
EXAM COVERAGE - Elevance Health Certification
The Elevance Health Certification evaluates knowledge and
competencies required to work within health insurance, managed
care, and member services. The exam covers health plan policies,
claims processing, utilization management, and quality improvement
programs. Candidates are tested on regulatory compliance, including
HIPAA, CMS guidelines, and state/federal healthcare regulations.
Additional topics include customer service, care coordination,
behavioral and physical health benefits, and risk management. The
exam emphasizes accurate documentation, ethical practices, effective
communication, and application of insurance and clinical knowledge
to ensure quality member care and operational compliance.
,Which of the following statements is NOT true about a disenrollment?
Disenrollment requests can be taken verbally
How does a cancellation differ from a disenrollment?
Both A and B are correct (A cancellation applies if a request is
received prior to a member's effective date or by the date on the
Outbound Enrollment Verification (OEV) letter, Cancellation requests
are initiated by the member and can be received either verbally or in
writing)
, FEMA disaster SEPs can only be used if members missed a valid
enrollment period.
True
The Special Election Period (SEP) for Dual Eligible and Other LIS
Eligible Individuals previously allowed one time per-calendar-quarter
during the first nine months of the year was replaced beginning
Calendar Year 2025 with a monthly SEP to enroll in a standalone PDP.
Eligible beneficiaries can switch PDPs or leave a MA/MAPD plan for
Original Medicare plus a standalone PDP.
True
EXAM COVERAGE - Elevance Health Certification
The Elevance Health Certification evaluates knowledge and
competencies required to work within health insurance, managed
care, and member services. The exam covers health plan policies,
claims processing, utilization management, and quality improvement
programs. Candidates are tested on regulatory compliance, including
HIPAA, CMS guidelines, and state/federal healthcare regulations.
Additional topics include customer service, care coordination,
behavioral and physical health benefits, and risk management. The
exam emphasizes accurate documentation, ethical practices, effective
communication, and application of insurance and clinical knowledge
to ensure quality member care and operational compliance.
,Which of the following statements is NOT true about a disenrollment?
Disenrollment requests can be taken verbally
How does a cancellation differ from a disenrollment?
Both A and B are correct (A cancellation applies if a request is
received prior to a member's effective date or by the date on the
Outbound Enrollment Verification (OEV) letter, Cancellation requests
are initiated by the member and can be received either verbally or in
writing)
, FEMA disaster SEPs can only be used if members missed a valid
enrollment period.
True
The Special Election Period (SEP) for Dual Eligible and Other LIS
Eligible Individuals previously allowed one time per-calendar-quarter
during the first nine months of the year was replaced beginning
Calendar Year 2025 with a monthly SEP to enroll in a standalone PDP.
Eligible beneficiaries can switch PDPs or leave a MA/MAPD plan for
Original Medicare plus a standalone PDP.
True
