Centene Midterm 50 questions with complete solutions
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How long can member be out of their area without being disenrolled?
Over 6 months
1 year
Less than 6 months
8 months
Less than 6 months
Who is the Medicare Part B monthly premium paid to?
CMS
The member
Private insurance company
CMS
How does a member request to sign up for an Optional Supplemental Benefits
package?
Call and speak with the Sales Department
Online through the Member Service Portal
Request to meet with a Broker in person
Mail in the Optional Benefits Individual Enrollment Form
Mail in the Optional Benefits Individual Enrollment Form
An example of Concierge Customer Service would be anticipating a member's
needs and going out of your way to minimize a caller's effort.
True
False
True
Which of the following actions would require you to leave a note within the
intent? (Pick 2)
If you had to make an outgoing call
If the intent captures all relevant information
If you had to locate information outside of Omni You must include a note in every
intent
If you had to make an outgoing call
If you had to locate information outside of Omni
Which intents require the use of a template for the intent-level notes? (Pick 3)
Pharmacy claims inquiry
issues
Medical claims inquiry
Medical authorization inquiry
Pharmacy authorization inquiry
issues
Medical authorization inquiry
Pharmacy authorization inquiry
If you open up the Gaps in Care intent and the member has none open, you would
need to make note of that in the Final Call Summary field?
, True
False
False
When can a DSNP member disenroll? (Pick 2)
Annual Enrollment Period
one time every month
One time every quarter for the first 9 months of the year
Anytime they want
Twice every month of the year
Annual Enrollment Period
One time every quarter for the first 9 months of the year
CSRs will inform callers of interpreter services being free.
True
False
True
How do you document prospective member and CMS test calls in Omni?
Other action > Exit interaction
Other action > Member not found > Benefits & Eligibility inquiry
Other action > Member not found > Log view status
No note is needed
Other action > Member not found > Log view status
The following items may be used for HIPPA verification except:
Member name
email
Last 4 SSN
Member date of birth
Member ID number
email
It is permissible in some situations to provide medical advice to members.
True
False
False
When quoting PPO benefits to a member, you should quote both ____ and ____
benefits and cost shares? (Pick 2)
In-Network
Non-Covered
Out of Network
Covered
In-Network
Out of Network
Transportation, Over the Counter, and Gym membership are examples of
_________ _________.
None of the ones mentioned
Supplemental Benefits
rewards Program
Contest Prizes
already passed!!
How long can member be out of their area without being disenrolled?
Over 6 months
1 year
Less than 6 months
8 months
Less than 6 months
Who is the Medicare Part B monthly premium paid to?
CMS
The member
Private insurance company
CMS
How does a member request to sign up for an Optional Supplemental Benefits
package?
Call and speak with the Sales Department
Online through the Member Service Portal
Request to meet with a Broker in person
Mail in the Optional Benefits Individual Enrollment Form
Mail in the Optional Benefits Individual Enrollment Form
An example of Concierge Customer Service would be anticipating a member's
needs and going out of your way to minimize a caller's effort.
True
False
True
Which of the following actions would require you to leave a note within the
intent? (Pick 2)
If you had to make an outgoing call
If the intent captures all relevant information
If you had to locate information outside of Omni You must include a note in every
intent
If you had to make an outgoing call
If you had to locate information outside of Omni
Which intents require the use of a template for the intent-level notes? (Pick 3)
Pharmacy claims inquiry
issues
Medical claims inquiry
Medical authorization inquiry
Pharmacy authorization inquiry
issues
Medical authorization inquiry
Pharmacy authorization inquiry
If you open up the Gaps in Care intent and the member has none open, you would
need to make note of that in the Final Call Summary field?
, True
False
False
When can a DSNP member disenroll? (Pick 2)
Annual Enrollment Period
one time every month
One time every quarter for the first 9 months of the year
Anytime they want
Twice every month of the year
Annual Enrollment Period
One time every quarter for the first 9 months of the year
CSRs will inform callers of interpreter services being free.
True
False
True
How do you document prospective member and CMS test calls in Omni?
Other action > Exit interaction
Other action > Member not found > Benefits & Eligibility inquiry
Other action > Member not found > Log view status
No note is needed
Other action > Member not found > Log view status
The following items may be used for HIPPA verification except:
Member name
Last 4 SSN
Member date of birth
Member ID number
It is permissible in some situations to provide medical advice to members.
True
False
False
When quoting PPO benefits to a member, you should quote both ____ and ____
benefits and cost shares? (Pick 2)
In-Network
Non-Covered
Out of Network
Covered
In-Network
Out of Network
Transportation, Over the Counter, and Gym membership are examples of
_________ _________.
None of the ones mentioned
Supplemental Benefits
rewards Program
Contest Prizes
