2015 Smmc Verification Procedure Questions

If a Confidentiality Code appears in the address field, it means that there is a requirement for the caller to verify it in order to pass the verification process. This suggests that the Confidentiality Code serves as a security measure to ensure that only authorized individuals are able to access or communicate sensitive information. Therefore, the statement "True" indicates that the caller indeed has to verify the Confidentiality Code for successful verification.

The agent should advise Roger to fax in legal documentation (POA), complete verification, and continue with the call. This is because simply stating that he has Power of Attorney is not sufficient proof. The agent needs to verify the authenticity of the claim by requesting legal documentation. Once the documentation is received and verification is completed, the agent can proceed with the call.

This statement suggests that when verifying information, agents should always ask for the full physical address first. The county can only be used as a substitute if the caller is unable to provide or verify the physical address on file. Therefore, the answer is true as it emphasizes the importance of obtaining the complete physical address before considering the county as an alternative.

DCF or CBC workers must complete verification and provide their Name, Agency & Title, Work phone number, and provide detail on how they are authorized to make decisions for the child. This is necessary in order to ensure that the worker is authorized to act on behalf of the child and make decisions regarding their welfare. It also helps to establish the worker's identity and contact information for communication purposes.

The correct answer is that underage parents can call to enroll their children. This means that even though Keith is only 15 years old, he is still able to call and enroll his newborn child into a plan. There is no restriction on underage parents being able to make this call.

If the member verified a new address in the SAME region, the correct action is to process an enrollment/plan change. However, the caller should be informed that they may not receive their mail and should be referred to DCF/SSA to update the address. This ensures that the member's enrollment or plan change is processed correctly, but also alerts them to the potential issue of not receiving mail at the new address and provides them with the appropriate resources to update their address with relevant agencies.

The answer is asking the caller to verify the complete address including the state because the given address only includes the street and zip code. In order to proceed with the call, it is necessary to have the complete address, including the state, to ensure accurate information and proper routing.

If the caller has no idea about the PIN, the appropriate course of action is to inform the caller that the PIN can be reset after verification is completed. This implies that the caller will need to go through a verification process in order to reset the PIN. This ensures that the caller's identity is confirmed before any changes are made to the PIN, providing security and preventing unauthorized access.

If Teresa is unable to verify her physical address, the best course of action is to ask for the county. If the county can be verified, the call should continue and Teresa should be referred to DCF/SSA to update her address. This ensures that Teresa's address can be properly updated and any necessary changes can be made to her plan.

When a name is listed in the address field with C/O (in care of), it means that the person receiving the mail or package is not the intended recipient. Therefore, the caller must still follow the normal verification procedures to ensure that they are speaking to the correct person and that their request or inquiry is valid. Simply listing a name with C/O does not automatically authorize the caller or grant them access without verification.

If the member calls in for themselves and verifies all their information but then wants another person to speak on their behalf, the appropriate course of action is to continue the call. Once the recipient has verified their information, they can authorize someone else to speak for them. This ensures that the recipient is aware and in control of who is speaking on their behalf, while also allowing for the possibility of assistance from another person if needed.

If the member verifies a new address in a different region, the correct course of action is to not process an enrollment/plan change. Instead, the agent should assist the caller with any case-specific questions they may have and refer them to the appropriate department (DCF/SSA) to update their address. This is because the change in region may affect the member's eligibility or coverage, and it is important to ensure that the address is updated correctly in the system. Asking for the county and the last 5 digits of the member's SSN are not relevant in this situation.

The correct answer is that the counselor should notify Stacie that legal documentation of her emancipation must be faxed in before she can speak for herself; she can continue the call on the newborn's behalf. This is because even if Stacie claims to be emancipated, the counselor needs proper documentation to verify her status and allow her to speak on her own behalf.

If the member calls in for themselves and verifies all their information but then wants another person to speak on their behalf, the correct procedure is to continue the call. Once the recipient has verified their information, they can authorize someone else to speak for them. This means that the person who initially called can give permission for another individual to speak on their behalf during the call.

The correct answer is No. Once faxed in, the document will be added to HealthTrack and the caller does not need to fax in another copy. If the document has an expiration date that has expired, then the DAR must be faxed again. This means that as long as the DAR is valid and has not expired, the caller does not need to send in another signed copy every time they call in. However, if the DAR has expired, it needs to be faxed again to ensure that the member has an updated DAR on file.

The correct answer is to tell Rosa to send in a signed copy of the DAR form or the legal documentation and continue the call. This is because the grandmother claims to be the child's Power of Attorney, which means she has legal authority to make decisions on behalf of the child. By requesting the DAR form or legal documentation, it ensures that the grandmother's claims are verified before proceeding with any plan changes.

The correct answer is "No, the agent may skip that question if they are calling for themselves." This is because if Jeremy Spencer is calling to enroll himself into United Healthcare of Florida, he does not need to ask himself if he has authority or permission to obtain information or make changes for himself. The question is only necessary when someone is calling on behalf of someone else.

The correct answer is "Yes. Ask every caller for the security PIN." This is necessary because even if the member is calling for themselves, there is still a possibility that the caller may not really be the member. Asking for the security PIN helps to verify the identity of the caller and ensure the security of the information being shared.

If the caller verifies the address correctly but provides additional information for the street address that is not listed on the case, the appropriate course of action is to continue with the call and refer the caller to the DCF/SSA to update the address. This ensures that the correct information is recorded and any necessary updates can be made by the appropriate agency.

The statement is false because the scenario does not mention anything about Ms. Janis needing to send in a DAR form to prove she has authority over Tom.

The correct answer is to tell Sue about the DAR form and how to send it in so it can be added to the case and continue with the call. This is the appropriate course of action because the DAR form is used to authorize someone to speak on behalf of another individual. Since Sue states that she is now caring for her mother's affairs, it is necessary to inform her about the DAR form and guide her on how to submit it. Once the form is received and processed, Sue will be able to continue with the call and discuss her mother's case.

In this situation, it is important to prioritize the security and privacy of the individual's personal information. Since Justin cannot verify his wife's year of birth, it is not appropriate to continue with the call as it could potentially lead to unauthorized access to sensitive information.

The correct answer is True. The question states that Robert Robinson is calling for his older sister Susanne Robinson and he has the Security PIN. The question specifically states not to ask Robert if he has authority or permission to obtain information or make changes for the person he is calling for today. Therefore, it can be inferred that Robert is authorized to make the call and has the necessary credentials to access the information or make changes.

The correct answer is to inform the mother that she must send in a signed copy of the Designated Authorized Representative form and refer the caller to the SMMC website to obtain the DAR form. This is the appropriate procedure to follow when the caller does not have the PIN. By providing the necessary information and directing the caller to the website, the mother can proceed with verifying her son's eligibility.

The correct answer is to ask the caller if they have authority or permission to obtain information or make changes for the person they are calling for. If the caller states they have the authority, inform them to send in a signed copy of the DAR form (if needed). Additionally, ask the caller for the name, year of birth, and physical address for one of the persons they are calling for and continue with the call. This ensures that the caller has the necessary authorization and provides the necessary information to proceed with the call.