2021 Centene ACT Mastery Exam / Mastery Exam 3 Study Guide 2021 / ACT Practice Exam - 2021 WPH

In 2021, Centene is offering which of the the following types of Medicare Advantage Prescription Drug (MAPD) products? A. HMO and HMO/POS B. DSNP and CSNP C. PPO D. PFFS Ans - E. All of the above Beneficiaries who are first eligible for Medicare have a seven-month Initial Enrollment Period to enroll in a Medicare Advantage Plan. If eligible for Medicare, beneficiaries can sign up during the seven-month period that: A. Begins three months before the month in which the member turns 65. B. Includes the month in which the member turns 65. C. Ends three months after the month in which the member turns 65. Ans - D. All the above Per CMS, all telephonic enrollment must be completed on a recorded call. Ans - T Upon completion of the application, you must provide the beneficiary with the enrollment application confirmation ID. Ans - T Agents may be investigated after being suspected of noncompliant activity reported through a Complaint Tracking Module (CTM), grievance, secret shop finding, internal audit or reporting. Ans - T If the application is being completed by an authorized representative, all corresponding fields must be completed. Ans - T A score of 85% or higher is needed to pass the 2021 ACT Mastery Exam. Ans - T When should you verify a beneficiary's eligibility for D-SNP? Ans - Before the enrollment The Centene product expansion has increased 5% from 2020. Ans - T Generics and brand name drugs are covered on which Part D drug tiers? A. Tiers 1 and 2 B. Tiers 3 and 4 C. Tier 5 Ans - D. All of the above OEP runs from January 1 to March 31. Which of the following statements apply: A. Beneficiaries can switch to another MA or MAPD Plan (including adding or removing drug coverage). B. Beneficiaries can disenroll from an MA or MAPD Plan and join Original Medicare with or without a stand-alone Part D Plan. C. Beneficiaries enrolled in Original Medicare cannot join an MA or MAPD plan. Ans - D. All the above To ensure accurate data entry, you should repeat the Medicare ID back to the beneficiary. Ans - T Which of the following are plans offered by Centene for beneficiaries that have special needs? Ans - Both DSNP and CSNP Which of the following are examples of potential disciplinary actions that could be issued against an agent? A) Verbal coaching B) Corrective Action Plan C) Written warning D) Termination not for cause Ans - All of the above An agent could be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information. Ans - T Which of the following is not an ancillary benefit on Centene's Medicare Advantage plans? Ans - Personal shopping services When enrolling a beneficiary, you should ensure that you enter the provider ID of a specialist and not a primary care physician (PCP). Ans - F Centene currently serves over 23 million Managed Care members. Ans - T The Minimum Necessary Rule within the Privacy Rule requires that any request or distribution of PHI includes only the minimum amount of PHI required to complete the intended task. This includes email and physical distribution. Ans - T New for 2021- Walgreens added to preferred network, along with CVS and most grocers, for 5 of 6 plans. Ans - T For plan year 2021, our PPO offerings have doubled. Ans - T Across Centene's nationwide Medicaid and Medicare footprint, we serve: A. 1 in 15 Americans B. 1 in 5 Americans C. 1 in 10 American D. 1 in 25 Americans Ans - NOT D PII stands for Personally Identifiable Information and includes any information that permits the identity of an individual to be inferred, including in