Questions and Answers
During an appointment, you may not discuss any products not agreed to in advance by the beneficiary.
True
When a paper SOA form is used, it must be completed __________ hosting the sales presentation.
Prior to
Brokers/Agents can submit a support ticket online through their Centene Workbench portal.
True
Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed.
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Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity?
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Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are:
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Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing.
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Health plan fax numbers vary for health plans that offer fax enrollment submissions.
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Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy.
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A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue.
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Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task.
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Beneficiary-facing content that includes generic or plan-specific product or benefit information must be submitted for review and CMS submission, as well as acceptance or approval, prior to distribution.
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A broker/agent may be terminated for cause if they fail to comply with a compliance investigation.
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Failure to inform a beneficiary that a trusted provider is out-of-network or is not available in the newly selected plan can cause a sales allegation.
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A Health Risk Assessment (HRA) can be completed for C-SNP and D-SNP plans only, before the enrollment application process in Ascend.
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What are some examples of what can trigger a beneficiary complaint? (Select all that apply)
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A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan.
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Prior to completing the enrollment form, you should always confirm the beneficiary's primary care physician (PCP) and/or specialists.
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The _________ plan is expected to have one of the lowest premiums in the country!
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Wellcare added ___ counties to their footprint for 2023.
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The Wellcare preferred pharmacy network includes Walgreens, CVS, and many grocery chains in 2023.
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____ PDPs will be offered across all 50 U.S. states and Washington, D.C.
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All PDPs will continue to offer $0 tier 1 preferred cost-sharing through CVS Medication Home Delivery (Mail Order).
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There are ___ LIS copay categories that could be assigned to a member, depending on the level of need.
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Which standalone Prescription Drug Plan is best for a dual-eligible chooser?
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For 2023, Ascension Complete added 27 new counties to their footprint.
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For PDP Medication Home Delivery, the ____ plan will continue to offer a discount for 90-day tier 2, tier 3, and tier 6 prescriptions.
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Centene's 2023 product expansion represents a __% increase from 2022.
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Centene has new PPO D-SNP product expansion in CT, IN, KS, KY, MS, OH, OK, PA, SC, and a new HMO D-SNP in LA.
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Value Script and Value Plus PDP products have a ___-tier formulary structure for 2023.
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Wellcare offers a range of Medicare plans to provide members with affordable access to:
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What type of inquiries can Wellcare's Corporate Sales Support team assist with?
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Ascend is a fast, easy, and compliant way for brokers/agents to submit agent-assisted electronic enrollments.
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From October 1st to October 14th, which activity is not permissible by brokers/agents?
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Which of the following statements about Scope of Appointment (SOA) is FALSE?
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Low-Income Subsidy (LIS)/Medicaid Lookup status verification in Ascend is:
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Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods?
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Which of the following is not an example of Protected Health Information (PHI)?
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Wellcare must receive notice of an event change or cancellation as soon as possible, but no later than 30 minutes after the event start time.
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The Single Sign-On Portal provides access to several applications, including Centene Workbench.
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Once the enrollment is completed, you can save a copy of the application for your reference.
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Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary.
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Communication of PHI can be:
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Brokers/Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare Products.
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Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Which of the following is not a Wellcare quality driver?
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Centene continues to expand its reach by offering more products in a wider geography. ____ new Wellcare and Ascension Complete plans are going to market.
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The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on all Value Script, Value Plus PDPs, and select Wellcare MAPD plans.
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All PDPs will feature a $0 tier 1 benefit when filled at preferred pharmacies.
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Which of the following is not considered a grievance?
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The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA).
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The NEW online Centene Workbench self-service portal enables you to:
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What are some examples of steps that can be taken when safeguarding and securing PHI and PII?
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______ events are designed to inform the people that attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier.
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You can help prevent grievances by:
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Which elements are available as part of Wellcare's sales support model?
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A Health Risk Assessment (HRA):
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When discussing prescription drug coverage, you should:
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The information contained within ACT will equip brokers/agents to certify, market, and sell which health plans?
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Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a:
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Which resources are available for download from the Shared Resources section found within Centene Workbench?
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Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud.
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Enrollments through Ascend offer the following unique benefits:
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Study Notes
Compliance and Ethics
- Discussing products with beneficiaries must follow prior agreements.
- Paper Scope of Appointment (SOA) forms must be completed before sales presentations.
- Brokers/agents can submit support tickets via the Centene Workbench portal.
- Wellcare requires notification of all marketing events, both formal and informal.
- Noncompliance allegations necessitate prompt communication with investigators, including providing documents.
- Brokers/agents can face termination for failure to comply during investigations or providing false information.
Enrollment Procedures
- Accurate enrollment period notation prevents processing delays.
- Health plan fax numbers vary for enrollment submissions.
- Enrollments should be completed in no more than one calendar day after beneficiary receipt.
- Confirmation of the beneficiary's primary care physician (PCP) is vital before enrollment.
Health Risk Assessment (HRA)
- HRAs are not limited to C-SNP and D-SNP plans; they can be applied to other plans.
Product Offerings and Plans
- Wellcare introduced 209 new counties for 2023 and maintains a broad pharmacy network including Walgreens and CVS.
- Three PDPs will be featured across all U.S. states, with $0 tier 1 preferred cost-sharing available.
- Four Low-Income Subsidy (LIS) copay categories exist based on member needs.
- Value Script, Value Plus, and Classic are the primary PDP options available.
Quality and Service Standards
- Brokers/agents must comply with all contracting and training requirements to sell Wellcare products.
- Medicare Star Ratings influence Wellcare's quality strategy, with member service being a key driver.
- Communication of Protected Health Information (PHI) can be written, electronic, or verbal, ensuring confidentiality.
Support and Resources
- Wellcare's Corporate Sales Support assists with applications, onboarding, and commissions.
- Ascend is a compliant platform for submitting electronic enrollments.
- PHI must adhere to the principle of minimum necessary disclosure.
Grievances and Complaints
- Grievances can arise from unauthorized enrollment, misinformation, or provider network issues.
- An event cancellation notice must be communicated timely, within 30 minutes.
Training and Certification
- Brokers must complete necessary training and certification to be eligible for selling Wellcare's Medicare products.
- Centene offers a 3% increase in product expansion compared to the previous year, showing growth in service reach.
Data Storage and Protection
- Member PHI should not be stored on external hard drives or cloud services to ensure privacy.
- Steps to safeguard PHI are essential in compliance with regulations and best practices.
Scope of Appointment (SOA)
- SOAs must clearly indicate the product types discussed during beneficiary appointments.
- Only compliant practices regarding SOAs ensure adherence to guidelines and foster ethical relationships with beneficiaries.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge with these essential flashcards designed for the 2023 Wellcare Mastery Test. Each card covers critical concepts related to beneficiary discussions, SOA forms, and broker support. Perfect for anyone preparing for certification in this area.
