2018 Fl Smmc Verification Quiz
The 2018 FL SMMC Verification Quiz assesses knowledge in managing plan changes and enrollments in Florida's Statewide Medicaid Managed Care. It tests verification procedures, handling exceptions, and compliance with healthcare regulations, essential for administrative roles in healthcare.
- 1.
Rosa calls to make a plan change for her daughter Ashley. Ashley is 12 years old. Rosa does not have the pin number listed on the case. How do you proceed?
- A.
• Tell Rosa that she is not the authorized person on the case because Ashley is an adult and you cannot continue with the call.
- B.
• Advise Rosa to look through her mail for the PIN number and to give us a call back once she finds it.
- C.
• Refer Rosa to AHCA to request that another PIN number be sent to her because someone may have taken it.
- D.
• Ask Rosa whether she has authority for Ashley because she does not have the PIN, and continue with verification because she is the parent.
Correct Answer
D. • Ask Rosa whether she has authority for Ashley because she does not have the PIN, and continue with verification because she is the parent.Explanation
The correct answer is to ask Rosa whether she has authority for Ashley because she does not have the PIN, and continue with verification because she is the parent. This is the appropriate course of action because even though Rosa does not have the PIN number, she is the parent of Ashley and therefore likely has the authority to make changes on her behalf. It is important to verify this information before proceeding with the call.Rate this question:
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- 2.
Megan is calling to enroll all three children Nathan, Joseph and Mia Johnson into a plan. How do you proceed?
- A.
• Verify name, year of birth and physical address for all three recipients.
- B.
• Verify name, year of birth, physical address and Social Security number for all three recipients.
- C.
• The children are not eligible which means that Megan does not have to verify name, year of birth, and physical address for them.
- D.
• Verify full name, year of birth, and physical address for one of the three children and only verify the full names of the other two children.
Correct Answer
D. • Verify full name, year of birth, and physical address for one of the three children and only verify the full names of the other two children.Explanation
The correct answer is to verify the full name, year of birth, and physical address for one of the three children and only verify the full names of the other two children. This option allows for the necessary verification of information for at least one child, while also recognizing that the other two children do not need their full information verified. This approach ensures efficiency while still meeting the necessary requirements for enrollment.Rate this question:
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- 3.
Robert Mansfield calls to change his plan to Sunshine State Health Plan because he recently moved from Pasco County. Robert states that he now lives in Liberty County, but Health Track still shows Pasco County. How should you proceed?
- A.
• After Robert passes verification the address can be updated in HealthTrack, it does not matter that the county and region are different. Process a plan change to a plan in Liberty County.
- B.
• Robert cannot change plans at this time because he now lives in a different region from what's listed in Health Track. Assist with case specific information and refer him to DCF/SSA to update his address.
- C.
• Robert cannot change his plan Sunshine because the same plan is offered in Liberty County. Refer Robert to the plan for services.
- D.
• Robert can change his plan to Sunshine Health if he agrees to fax in a letter with the correct address on it.
Correct Answer
B. • Robert cannot change plans at this time because he now lives in a different region from what's listed in Health Track. Assist with case specific information and refer him to DCF/SSA to update his address.Explanation
The correct answer is that Robert cannot change plans at this time because he now lives in a different region from what's listed in Health Track. The explanation for this is that Health Track still shows Pasco County as Robert's location, but he claims to now live in Liberty County. In order to update his address and proceed with a plan change, it is necessary for Robert to contact DCF/SSA to update his address information.Rate this question:
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- 4.
Teresa Sullivan is calling to change her plan. HealthTrack does not show a physical address and only shows her mailing address. Teresa was able to verify her current mailing address, and states she does not have a physical address. How should you proceed?
- A.
• Continue with the call but refer to DCF/ SSA, and just advise Teresa to have DCF/SSA add her mailing address as her physical address.
- B.
• Refer Teresa to DCF/SSA to update the physical address and do not continue the call.
- C.
• Advise Teresa that she needs to submit proof of residence to AHCA because her physical address is blank.
- D.
• Since the mailing address was verified, continue with the call without referring.
Correct Answer
D. • Since the mailing address was verified, continue with the call without referring.Explanation
The correct answer is to continue with the call without referring because Teresa has verified her current mailing address. While she does not have a physical address, this does not prevent her from continuing with the call.Rate this question:
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- 5.
Once Jonathan Fernandez completed his enrollment, he asked the agent, "What is the mailing address on file?" What should the agent do?
- A.
• Inform Jonathan of the address that we currently have on file.
- B.
• Refer Jonathan to contact DCF to confirm the mailing address in their system.
- C.
• Ask the caller to provide the mailing address first, and then confirm if the mailing address is correct.
- D.
• Refer Jonathan to a supervisor for further assistance because we do not verify the mailing address.
Correct Answer
C. • Ask the caller to provide the mailing address first, and then confirm if the mailing address is correct.Explanation
The agent should ask the caller to provide the mailing address first and then confirm if the mailing address is correct. This ensures that the agent has accurate information and can verify if the address on file matches the provided address.Rate this question:
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- 6.
Lawrence Olivier is calling to enroll wife Meredith into a LTC plan. He has the PIN number listed on the case. How should you proceed with the call?
- A.
• Since Lawrence has the PIN, he is authorized whether he is on the case or not.
- B.
• If Lawrence is not on the same case, he is not authorized to speak on his wife’s behalf.
- C.
• Verify if Lawrence is on the case. If he is not, ask if he has authority to make changes on his wife’s case and request the DAR.
- D.
• Even with the PIN, Lawrence will need a DAR whether he is on the case or not.
Correct Answer
C. • Verify if Lawrence is on the case. If he is not, ask if he has authority to make changes on his wife’s case and request the DAR.Explanation
The correct answer is to verify if Lawrence is on the case. If he is not, ask if he has authority to make changes on his wife's case and request the DAR. This is the appropriate procedure because even though Lawrence has the PIN number, it does not automatically grant him authorization to enroll his wife into a LTC plan. Therefore, it is important to confirm if he is listed on the case or if he has the authority to make changes on his wife's behalf. Requesting the DAR (Designated Authorized Representative) will help ensure that the appropriate person is authorized to make decisions regarding the enrollment.Rate this question:
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- 7.
John Hendricks is a representative from Magellan Complete Care and is calling to enroll recipient Laetitia Phillips. Can the agent continue with the call?
- A.
• Yes, as long as John verify his name, title, phone number and provide a Statement of Authority.
- B.
• Yes, because Laetitia stated she authorizes John to speak on her behalf.
- C.
• No. Agents cannot speak with health plan representatives. Do not continue the call.
- D.
• Yes, because John Hendricks works for a specialty plan and specialty plan representatives may speak on behalf of recipients.
Correct Answer
C. • No. Agents cannot speak with health plan representatives. Do not continue the call. -
- 8.
Holly Morton wants to know where the Security PIN Number can be found. How should the agent respond?
- A.
• Ms. Morton, the Security PIN number is found on the welcome letter.
- B.
• Ms. Morton, your Security PIN Number is found on the welcome letter and is 1098.
- C.
• Ms. Morton, you are supposed to know your Security PIN Number. Please, do not ask me for that information.
- D.
• Ms. Morton, you may contact DCF to obtain your Security PIN Number.
Correct Answer
A. • Ms. Morton, the Security PIN number is found on the welcome letter.Explanation
The agent should respond by informing Ms. Morton that the Security PIN number can be found on the welcome letter.Rate this question:
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- 9.
Melissa Rodriguez just completed a plan change for her children Thomas and Mary. Before closing the call, she asks the agent if she can be given the Security PIN number. Is the agent allowed to disclose the Security PIN number?
- A.
• Yes, because Melissa did verify all the personal information for all enrollees and is authorized.
- B.
• Yes, because Melissa is the legal guardian for her children Thomas and Mary.
- C.
• Yes, because DCF has determined that the Security PIN number must be given to parents only.
- D.
• No. Agents are not allowed to disclose the Security PIN number unless it has already been confirmed by the caller. Agents can only change/update the PIN number.
Correct Answer
D. • No. Agents are not allowed to disclose the Security PIN number unless it has already been confirmed by the caller. Agents can only change/update the PIN number.Explanation
The agent is not allowed to disclose the Security PIN number unless it has already been confirmed by the caller. Agents can only change/update the PIN number. This is to ensure the security and privacy of the caller's personal information.Rate this question:
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- 10.
Sandy Morgan calls in to enroll Michael Gordon into CMS. She states she is a case worker for the Department of Children and Families. How should the agent proceed if the case worker does not have the PIN?
- A.
• Advise Sandy that she is not authorized on the case and cannot continue with the call.
- B.
• Advise Sandy that she must have authorization from Michael's parents to continue with the call and complete enrollment.
- C.
• Document the name, agency, title, work phone number and request Sandy to provide detail on how she is authorized to make decisions for the enrollee.
- D.
• Advise Sandy to complete the Designated Authorized Representative form to continue with the call.
Correct Answer
C. • Document the name, agency, title, work phone number and request Sandy to provide detail on how she is authorized to make decisions for the enrollee.Explanation
If the case worker does not have the PIN, the agent should document the name, agency, title, work phone number, and request Sandy to provide detail on how she is authorized to make decisions for the enrollee. This is important to ensure that the case worker has the necessary authorization to enroll Michael Gordon into CMS. By documenting this information and requesting further details, the agent can verify Sandy's credentials and determine if she is authorized to proceed with the call and complete the enrollment process.Rate this question:
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- 11.
Roger Guinness is calling to enroll his mother Alice Munro into an LTC plan. He states he has Power of Attorney to speak on her behalf. What will Roger need to be authorized if he does not have the PIN and is not on the case?
- A.
• Since Roger volunteered that he has Power of Attorney for his mother, the agent may continue with the call without asking any verification questions.
- B.
• Continue with the call if Roger is listed as the payee on the case.
- C.
• Advise Roger to fax in legal documentation (POA), complete verification, and continue with the call.
- D.
• Advise Roger that his mom should speak for herself.
Correct Answer
C. • Advise Roger to fax in legal documentation (POA), complete verification, and continue with the call.Explanation
The correct answer is to advise Roger to fax in legal documentation (POA), complete verification, and continue with the call. This is because even though Roger claims to have Power of Attorney, it is important to have proper legal documentation to verify his authority. By requesting him to fax in the POA, the agent can ensure that Roger is authorized to speak on behalf of his mother and proceed with the enrollment process.Rate this question:
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- 12.
Keith Collins is calling to enroll his newborn child into a plan. Keith is 15 years old. Can the agent continue with the call?
- A.
• No, because underage parent cannot enroll their children.
- B.
• Yes, underage parents can call to enroll their children.
- C.
• No, Keith needs to fax a Statement of Authority in order for the agent to continue with the call.
- D.
• No, because Keith is not listed as the payee on the case.
Correct Answer
B. • Yes, underage parents can call to enroll their children. -
- 13.
Justin Taylor is calling to enroll his wife Brittany into a plan. He cannot verify Brittany's correct year of birth. Can the agent continue with the call?
- A.
• No, do not continue with the call because the caller must verify the name and year of birth to pass verification. Refer to DCF/SSA to verify/update the year of birth.
- B.
• Yes, because spouses are always authorized to obtain information or make changes.
- C.
• Yes, because the agent verified all of Justin's personal information.
- D.
• No, the agent should have the caller verify the social security number. If the SSN is verified, then continue the call.
Correct Answer
A. • No, do not continue with the call because the caller must verify the name and year of birth to pass verification. Refer to DCF/SSA to verify/update the year of birth.Explanation
The agent should not continue with the call because the caller must verify the name and year of birth to pass verification. In this case, Justin Taylor is calling to enroll his wife Brittany into a plan, but he cannot verify her correct year of birth. Therefore, the agent should refer to DCF/SSA to verify or update Brittany's year of birth before proceeding with the call.Rate this question:
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- 14.
Jodie Williams states that she is 15 years old, just had a baby and needs to enroll herself into Sunshine State Health Plan. Can the agent continue with the call?
- A.
• No, unless emancipation paperwork is on file in HealthTrack history.
- B.
• Yes, as long as she passes verification.
- C.
• Yes, because she has a Certificate of Authority from DCF and is calling just for herself.
- D.
• Yes, because underage recipients with special conditions on file may call for themselves even if emancipation paperwork is not on file.
Correct Answer
A. • No, unless emancipation paperwork is on file in HealthTrack history.Explanation
The agent cannot continue with the call unless there is emancipation paperwork on file in HealthTrack history. This suggests that Jodie Williams, being 15 years old and having just had a baby, may not have the legal capacity to enroll herself into Sunshine State Health Plan without the proper documentation of emancipation.Rate this question:
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- 15.
Olga Ramos states that her grandchildren are living with her temporarily and that she needs to change their plans. She does not have the pin number, but states that she has a letter from her daughter giving her permission to act her grandchildren's behalf. How should you proceed?
- A.
• Advise Mrs. Ramos to have the authorized parent to call to change her grandchildren's plan.
- B.
• Continue the call and take Mrs. Ramos' word since she said that she is the grandmother.
- C.
• Continue the call and advise Mrs. Ramos to send in the letter documenting her authority by fax, email or U.S. mail.
- D.
• Advise Mrs. Ramos that you are unable to continue the call because she is not authorized.
Correct Answer
C. • Continue the call and advise Mrs. Ramos to send in the letter documenting her authority by fax, email or U.S. mail.Explanation
The correct answer is to continue the call and advise Mrs. Ramos to send in the letter documenting her authority by fax, email, or U.S. mail. This is the appropriate course of action because Mrs. Ramos does not have the pin number, but she claims to have a letter from her daughter giving her permission to act on her grandchildren's behalf. By requesting the letter, it allows for proper verification and documentation of her authority, ensuring that the necessary changes can be made.Rate this question:
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- 16.
Can the agent change or update the Security PIN number?
- A.
• Yes, if the caller requests to change the Security PIN number.
- B.
• Never, the Security PIN number is only changed through AHCA.
- C.
• No. Caller should be referred to DCF to update the Security PIN number.
- D.
• None of the above.
Correct Answer
A. • Yes, if the caller requests to change the Security PIN number.Explanation
The correct answer is "Yes, if the caller requests to change the Security PIN number." This means that the agent has the ability to change or update the Security PIN number if the caller specifically asks for it.Rate this question:
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- 17.
Sue is calling for her elderly mother that suffers from dementia and recently had a stroke. Sue states she is now caring for all her mother's affairs. How should you proceed if Sue has the PIN, but is not listed on her mother's case?
- A.
• Tell Sue to place her mom on the phone to verify the personal information and if she authorizes Sue to speak on her behalf, continue the call.
- B.
• Tell Sue she can submit a DAR form via email, mail, or fax and continue with the verification process.
- C.
• Tell Sue that the DAR must be on file before case information can be provided, do not continue the call.
- D.
• Tell Sue to call SSA/DCF to be added as the payee on the case.
Correct Answer
B. • Tell Sue she can submit a DAR form via email, mail, or fax and continue with the verification process.Explanation
If Sue has the PIN but is not listed on her mother's case, the appropriate course of action would be to tell Sue that she can submit a DAR form via email, mail, or fax and continue with the verification process. This would allow Sue to provide the necessary documentation to prove her authority to access her mother's affairs and continue the call.Rate this question:
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- 18.
Robert Robinson is calling for his older sister, Suzanne Robinson. He has the security pin number, but cannot verify the zip code for her physical address. How should you proceed?
- A.
• Ask the caller to give us a call back once he can verify the physical address that's on file.
- B.
• After two failed attempts to verify the physical address on file, refer to DCF/SSA to verify and/or update the address.
- C.
• Ask the caller to verify the mailing address and refer to DCF/SSA to update the address.
- D.
• Ask the caller to fax in legal documentation of his authority to act on his sister's behalf to us.
Correct Answer
B. • After two failed attempts to verify the physical address on file, refer to DCF/SSA to verify and/or update the address.Explanation
If the caller cannot verify the zip code for Suzanne Robinson's physical address, the best course of action is to attempt to verify the address two more times. If these attempts are also unsuccessful, it is recommended to refer to the Department of Children and Families (DCF) or the Social Security Administration (SSA) to verify and/or update the address. This ensures that the correct and up-to-date address is used for any necessary communication or documentation.Rate this question:
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- 19.
Providing case information without verification is considered disclosing pHI and will result in a failed call.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
This statement is true because disclosing Protected Health Information (PHI) without proper verification is a violation of privacy laws and regulations. PHI includes any personal health information that can be used to identify an individual, such as medical records, treatment history, or insurance information. To ensure patient confidentiality and protect sensitive data, it is crucial to verify the identity and authorization of individuals before sharing any case information. Failure to do so can lead to serious consequences, including legal penalties and a failed call.Rate this question:
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- 20.
The caller is automatically authorized if they have the PIN.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The statement "The caller is automatically authorized if they have the PIN" is false. The presence of a PIN does not automatically authorize the caller. While the PIN may be a factor in the authorization process, there could be other criteria or steps that need to be fulfilled in order for the caller to be authorized.Rate this question:
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Mar 20, 2023Quiz Edited by
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Sep 20, 2017Quiz Created by
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