Smmc: Healthtrack Choice Tools Quiz
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- 1.
To change the LTC Direct Service Provider, the recipient should call the
- A.
DOEA
- B.
DCF
- C.
Care Coordinator
- D.
SSA
Correct Answer
C. Care CoordinatorExplanation
In order to change the LTC (Long-Term Care) Direct Service Provider, the recipient should contact the Care Coordinator. The Care Coordinator is responsible for coordinating and managing the recipient's long-term care services, including making any necessary changes to the service provider. The recipient should reach out to the Care Coordinator to discuss their needs and preferences and to request a change in the service provider if necessary.Rate this question:
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- 2.
"My grandfather has Crohn's Disease and he has to be very careful about what he eats. His stomach is very sensitive to a lot of foods. I take care of him, but I'm not sure what type of food is right for him. I don't want his condition to worsen because I'm not giving him the right foods." Which covered service is the recipient referring to?
- A.
Home Delivered Meals
- B.
Hospice
- C.
Personal Care
- D.
Nutritional Assessment/Risk Reduction Services
Correct Answer
D. Nutritional Assessment/Risk Reduction ServicesExplanation
The recipient is referring to Nutritional Assessment/Risk Reduction Services. They mention that their grandfather has a sensitive stomach and needs to be careful about what he eats. They express concern about not giving him the right foods and wanting to prevent his condition from worsening. Nutritional Assessment/Risk Reduction Services would involve assessing the individual's nutritional needs and providing guidance on appropriate foods to support their health condition.Rate this question:
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- 3.
James is wanting to find a Pediatric doctor for his child. Which Search field would you look under to find a Pediatric doctor?
- A.
Address
- B.
Gender
- C.
Panel Status
- D.
Specialty
Correct Answer
D. SpecialtyExplanation
To find a Pediatric doctor, James would look under the "Specialty" search field. This is because the specialty field is typically used to search for doctors who specialize in specific areas of medicine, such as pediatrics. By selecting the specialty field and entering "Pediatrics" as the search criteria, James can easily find a Pediatric doctor for his child.Rate this question:
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- 4.
Which box would you check to enroll into a medical plan?
- A.
LTC
- B.
Better Health
- C.
MMA
- D.
Humana Medical Plan
Correct Answer
C. MMAExplanation
MMA stands for Medicare Advantage, which is a type of medical plan offered by private insurance companies that provides Medicare benefits. Therefore, checking the box for MMA would indicate the choice to enroll into a medical plan.Rate this question:
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- 5.
Can an OB/GYN doctor be a PCP?
- A.
No, Never
- B.
Yes, as long as the member states they see them for Primary care needs as well.
- C.
Yes, as long as they are listed as a PCP.
- D.
Yes, they are a doctor.
Correct Answer
C. Yes, as long as they are listed as a PCP.Explanation
An OB/GYN doctor can be a PCP as long as they are listed as a PCP. This means that they are able to provide primary care services in addition to their specialization in obstetrics and gynecology. Being listed as a PCP indicates that they have the necessary training and qualifications to provide comprehensive primary care to patients.Rate this question:
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- 6.
You can search for a PCP using a zip code.
- A.
Yes, only in certain areas.
- B.
No, you can only use an exact address.
- C.
Yes, if you type in a zip code it will populate the PCP's in that area.
- D.
No, it would pull up to many PCP's in that area.
Correct Answer
C. Yes, if you type in a zip code it will populate the PCP's in that area.Explanation
The correct answer is "Yes, if you type in a zip code it will populate the PCP's in that area." This is because the statement in the question clearly states that you can search for a PCP using a zip code. Therefore, if you enter a zip code, the system will provide you with a list of PCPs in that particular area.Rate this question:
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- 7.
What plans can this member enroll into?
- A.
Magellan Complete Care (Specialty)
- B.
United Health Care of Florida
- C.
Sunshine Health
- D.
B and C
Correct Answer
D. B and CExplanation
This member can enroll into the plans offered by Sunshine Health and B and C.Rate this question:
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- 8.
Which plans does Dr. Rufus Joseph accept?
- A.
Simply Healthcare
- B.
Humana
- C.
Better Health
- D.
Amerigroup
Correct Answer
C. Better HealthExplanation
Dr. Rufus Joseph accepts Better Health as one of the plans he accepts.Rate this question:
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- 9.
Which search tool options can you use for MMA?
- A.
PCP Search only
- B.
Specialist Search only
- C.
Hospital Search only
- D.
You can search with Hospital, Specialist, and/or PCP.
Correct Answer
D. You can search with Hospital, Specialist, and/or PCP.Explanation
The correct answer is that you can search with Hospital, Specialist, and/or PCP. This means that when using the search tool for MMA, you have the option to search for hospitals, specialists, primary care physicians (PCP), or any combination of these options.Rate this question:
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- 10.
If a recipient is ready to enroll and requests a PCP, but you are unable to locate the doctor in Health Track, you should...
- A.
Tell the recipient to call the doctor to confirm the plans they accept. Advise the recipient that they may enroll without selecting a PCP, but they will have to contact the plan once it becomes effective to add the PCP of their choice or the plan will select one for them.
- B.
Tell the recipient that they can enroll without selecting a PCP and see any doctor that takes Medicaid. Because it really doesn't matter, you can select the first provider that populates under the plan that they requested in Health Track.
- C.
Advise the recipient that you will hold on while they look on the providers website to verify if it provides a list of plans they accept, even if they previously informed you that they do not have access to the internet.
- D.
Advise the recipient that the doctor must not accept Medicaid because they didn't pull up in the system at all and they must provide you with the name, address and/or telephone number of another doctor in order to enroll into a MMA plan.
Correct Answer
A. Tell the recipient to call the doctor to confirm the plans they accept. Advise the recipient that they may enroll without selecting a PCP, but they will have to contact the plan once it becomes effective to add the PCP of their choice or the plan will select one for them.Explanation
If you are unable to locate the doctor in Health Track, it is recommended to tell the recipient to call the doctor to confirm the plans they accept. They can enroll without selecting a PCP, but they will need to contact the plan once it becomes effective to add the PCP of their choice. If they do not do so, the plan will select one for them. This ensures that the recipient can still enroll and receive healthcare services, while also allowing them the opportunity to choose their preferred PCP once the plan is active.Rate this question:
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- 11.
Can you enroll this recipient with the PCP below?
- A.
Yes, if that is who the caller is requesting.
- B.
No, the recipient does not meet the age restrictions of the provider.
- C.
Yes, if the recipient is in Broward County.
- D.
No, because the provider is in Fort Lauderdale.
Correct Answer
B. No, the recipient does not meet the age restrictions of the provider.Explanation
The correct answer is "No, the recipient does not meet the age restrictions of the provider." This answer suggests that the recipient does not meet the required age criteria set by the provider for enrollment. Therefore, the enrollment cannot be done.Rate this question:
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- 12.
Scenario: Ms. Jones has used Meals on Wheels in the past for LTC. She would like to continue using Meals on Wheels. How should you proceed?
- A.
Search for Meals on Wheels and tell the caller which LTC plans they accept. Inform the caller that you cannot assign Meals on Wheels, but a Care Coordinator from the plan will help assign the providers once the plan is effective.
- B.
Search for Meals on Wheels and tell the caller which LTC plans they accept. Assign Meals on Wheels to the plan enrollment. Tell the caller she will receive this service when the plan starts.
- C.
Search for Meals on Wheels and tell the caller which LTC plans they accept. Tell the caller she will need to call Meals on Wheels directly for delivery and menu information.
- D.
Tell the caller she will receive a list of providers from the plan once it becomes effective. She should call DOEA to find out if Meals on Wheels works with LTC plans.
Correct Answer
A. Search for Meals on Wheels and tell the caller which LTC plans they accept. Inform the caller that you cannot assign Meals on Wheels, but a Care Coordinator from the plan will help assign the providers once the plan is effective. -
- 13.
If the caller does not have a PCP you should:
- A.
Offer to search for a PCP in the area, ask for preferences such as male or female, a language preference, etc.
- B.
Tell the caller to research the doctors in the area and call us back.
- C.
Tell the caller the plan will send a list of doctors when the plan becomes effective.
- D.
Provide the caller the plan website so they can get a full list of providers.
Correct Answer
A. Offer to search for a PCP in the area, ask for preferences such as male or female, a language preference, etc.Explanation
The correct answer is to offer to search for a PCP in the area and ask for preferences such as male or female, a language preference, etc. This is the most helpful and proactive response as it shows that the caller's needs and preferences are being taken into consideration. By offering to search for a PCP and asking for preferences, the caller will feel supported and guided in finding a suitable healthcare provider.Rate this question:
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- 14.
When will the member receive the health plan ID card and membership information from the plan?
- A.
After the enrollment becomes effective.
- B.
As soon as the member enrolls with the plan.
- C.
During open enrollment.
- D.
7-10 business days after the enrollment is completed.
Correct Answer
A. After the enrollment becomes effective.Explanation
After the enrollment becomes effective, the member will receive the health plan ID card and membership information from the plan. This means that once the enrollment process is completed and the plan is officially active, the member can expect to receive their ID card and membership details.Rate this question:
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- 15.
The caller is currently enrolled into a plan. The caller states that they are happy with the plan, but need to change the PCP. How do you proceed?
- A.
Tell the caller the doctor can only be changed during the 120 days.
- B.
Refer to the Medicaid Helpline to change the doctor.
- C.
Tell the caller to call the health plan to change the doctor.
- D.
Change the doctor through HealthTrack.
Correct Answer
C. Tell the caller to call the health plan to change the doctor.Explanation
The correct answer is to tell the caller to call the health plan to change the doctor. This is the appropriate course of action because the caller is currently enrolled in a plan and wants to change their Primary Care Physician (PCP). The health plan is responsible for managing and making changes to the caller's healthcare providers, so directing the caller to contact the health plan is the most efficient and effective way to proceed with the request.Rate this question:
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- 16.
Daniel Bannerman calls to enroll into Simply HealthCare. He states that he just moved from another state and does not have a Primary Care Provider. How do you proceed?
- A.
Inform Mr. Bannerman that in order to complete the enrollment, he is required to choose a Primary care Provider under the plan's network.
- B.
Inform Mr. Bannerman that he really doesn't need a primary care provider and that he can choose one whenever he wants to.
- C.
Inform Mr. Bannerman that you can help him find a PCP in the area and he is not required to choose a PCP at this time. If he does not choose one then the plan will assign a PCP.
- D.
Inform Mr. Bannerman that the plan will choose a doctor that doesn't have a lot of patients for him.
Correct Answer
C. Inform Mr. Bannerman that you can help him find a PCP in the area and he is not required to choose a PCP at this time. If he does not choose one then the plan will assign a PCP.Explanation
The correct answer is to inform Mr. Bannerman that you can help him find a PCP in the area and he is not required to choose a PCP at this time. If he does not choose one, then the plan will assign a PCP. This is the appropriate response because it acknowledges Mr. Bannerman's situation of not having a Primary Care Provider and offers assistance in finding one. It also informs him that if he does not make a choice, the plan will assign a PCP for him, ensuring that he has access to necessary healthcare services.Rate this question:
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- 17.
Mrs. Osborne calls to enroll into Humana with Dr. Imani Akindo. You search for the provider, but she does not show up in Health Track. Mrs. Osborne states that she just talked to the provider and was told that they accept Humana. How do you proceed?
- A.
Inform Mrs. Osborne that this is the most up-to-date information that we have received from the plan and that she can call the plan to add Dr. Imani Akindo once the plan become effective.
- B.
Advise Mrs. Osborne that Dr. Imani Akindo did not show under Humana and apparently no longer accepts Humana any more.
- C.
Inform Mrs. Osborne that this is the most up-to-date information that we have received from the plan and that Dr. Imani Akindo is not on the list and another provider will need to be selected.
- D.
Advise Mrs. Osborne that Dr. Imani Akindo accepts all of the plans available in her region, but she will have to call the plan to add her as the PCP.
Correct Answer
A. Inform Mrs. Osborne that this is the most up-to-date information that we have received from the plan and that she can call the plan to add Dr. Imani Akindo once the plan become effective.Explanation
The correct answer is to inform Mrs. Osborne that this is the most up-to-date information that we have received from the plan and that she can call the plan to add Dr. Imani Akindo once the plan becomes effective. This answer acknowledges that Dr. Imani Akindo is not currently listed as a provider in Health Track, but leaves open the possibility that she may be added in the future. It also provides a solution for Mrs. Osborne to contact the plan and make the necessary arrangements once the plan becomes effective.Rate this question:
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- 18.
Anita calls to enroll herself and her daughter in a plan. She wants to choose Prestige with her own PCP and states that her daughter's Pediatrician only accepts Staywell. Does Anita and her daughter have to enroll into the same plan because they are on the same case?
- A.
Yes, because the babies have to enroll in the same plan that the mother has.
- B.
Yes, because it's better for everyone to have the same plan and family doctor.
- C.
Yes, because AHCA requires that one plan and PCP per family for billing purposes.
- D.
No, she can choose a different plan and PCP for each member.
Correct Answer
D. No, she can choose a different plan and PCP for each member.Explanation
The correct answer is No, she can choose a different plan and PCP for each member. This is because there is no requirement for family members to enroll in the same plan or have the same PCP. Each individual can choose the plan and PCP that best suits their needs and preferences.Rate this question:
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- 19.
Affinity Home Care Inc. does not provide which service?
- A.
Medication Management
- B.
Respiratory Therapy
- C.
Home Accessibility Adaption Services
- D.
Homemaker
Correct Answer
C. Home Accessibility Adaption ServicesExplanation
Affinity Home Care Inc. does not provide Home Accessibility Adaption Services. This means that they do not offer services related to adapting homes for accessibility purposes, such as installing ramps or grab bars.Rate this question:
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- 20.
Barbara needs to verify if Broward Health Imperial Point hospital located in Fort Lauderdale, accepts Better Health plan. Barbara was unable to provide you with her Recipient ID, Medicaid ID,SSN nor any other numbers to access her case. How do you proceed?
- A.
Search for the provider using the Provider- MMA tool in Health Track menu bar.
- B.
Search for the provider using the Provider- LTC tool in Health Track menu bar.
- C.
Inform the caller that because you are unable to access the case and they must contact the plan to verify.
- D.
Inform the caller that the hospitals are required to accept all plans available in their region.
Correct Answer
A. Search for the provider using the Provider- MMA tool in Health Track menu bar. -
.PNG "Affinity Home Care Inc. does not provide which service?")
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Current Version
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Mar 20, 2023Quiz Edited by
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Dec 27, 2013Quiz Created by
AHSFLTrainer
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