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2024 Wellcare ACT Mastery Exam
Questions and Answers. A+ Graded.
Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. - ✔️ 1 Which elements are available as part of Wellcare's Sales Support model? - ✔️All of these Low-Income Subsidy (LIS), which is often referred to as Extra Help, reduces all Part D plan premiums - ✔️False Prior to completing the enrollment form, broker/agents should always confirm the beneficiary's primary care provider (PCP) and/or specialists - ✔️True At the end of this course, there will be a Mastery Exam. Agents must achieve a passing score of 85% or higher to successfully complete this course - ✔️True Brokers/Agents may be investigated after being suspected of noncompliant activity reported through a - ✔️Complaint Tracking Module (CTM) Grievance Secret Shop Finding A broker/agent who has never had any verbal warnings cannot be issued a Corrective Action Plan. - ✔️False Wellcare does not need to be informed of all marketing/sales events at which plans or materials will be presented or distributed (formaland informal). - ✔️False Marketing benefits in a service area where those benefits are not available is prohibited and considered misleading unless that is unavoidable because of local/regional or media use. - ✔️True CustomPoint sales material order dates will be posted on Wellcare.com - ✔️False The online Centene Workbench self-service portal enables you to - ✔️All of these
The TPMO disclaimer must be used by any TPMO that sells plans on behalf of more than one MA plan provider. The disclaimer must be: - ✔️Included in any marketing materials, including print materials and television advertisements developed, used, or distributed by the TPMO. Verbally conveyed within the first minute of a sales call. Prominently displayed on TPMO websites (regardless of content). Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content). Brokers/Agents can access the following resources under the Shared Resources section in Centene Workbench. - ✔️All of these Which of the following is not an example of Protected Health Information (PHI)? - ✔️Library Card When a paper SOA form is used, it must be completed __________ hosting the sales presentation. - ✔️48 Hours prior to Ascend is a fast, easy, and compliant way for brokers/agents to submit agent- assisted electronic enrollments. - ✔️True When explaining the provider network for D-SNPs and C-SNPs: - ✔️Avoid submitting applications with no primary care provider (PCP) to assist these higher-risk members. If a member is not connected to a primary care provider (PCP), we should always encourage and assist with connecting them with an in-network doctor If a requested effective date is available for the special election period being selected, ensure you are requesting a date within the correct time frame for the member based on their eligibility date or change date needed. - ✔️True Wellcare's _____ plan is designed for Low-Income Subsidy members. - ✔️Classic Which LIS category is assigned to members whose costs are fully subsidized and who receive the most assistance? - ✔️Three The _________ plan is expected to have one of the lowest premiums in the country!
Key areas you as a broker/agent have control over and impact upon regarding Star Ratings for quality are: - ✔️All of these Beneficiary-facing marketing materials for multiple MA organizations or plans must be submitted to the HPMS Marketing Module by the third-party marketing organization (TPMO) no later than 30 days of use. - ✔️False When completing an enrollment, be sure to use the correct enrollment application for the desired plan year. - ✔️True Providers may create co-branded marketing pieces using the Wellcare name and logo, as long as they are using the current, approved logo. - ✔️False Although options for capturing and submitting SOAs vary by health plan, Wellcare accepts SOAs in which of the following methods? - ✔️All of these 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. - ✔️True Which of the following is not considered a grievance? - ✔️A dispute of the appeal of an organization determination, coverage determination, or a Late Enrollment Penalty (LEP) determination. Brokers/Agents can access and download enrollment materials through CustomPoint. - ✔️True ______ events are designed to inform the people who attend about Medicare Advantage, Prescription Drug, or other Medicare programs without going into the specifics of a particular carrier. - ✔️Educational Materials that include plan comparisons or cost-sharing do not require CMS submission. - ✔️False Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Wellcare's quality focus consists of six drivers. Which of the following is not a Wellcare quality driver? - ✔️Member Payments The Pharmacy Benefit Manager (PBM) migration to Express Scripts effective 1/1/2024 will impact which plan(s)? -
✔️Both PDP & MAPD A Low-Income Subsidy (LIS) member will be assigned one of ____ copay categories depending on the level of need. - ✔️Four The 2024 Inflation Reduction Act (IRA) Part D Benefits include reduced insulin copays for all insulins and insulin-combination products that are on the formulary, regardless of tier, and are included in the $35 cap for one month's supply. - ✔️True Wellcare's 2024 product expansion represents a __% increase from 2023. - ✔️One CVS Caremark Mail Order will be in-network for 2024. - ✔️False Which Prescription Drug Plan (PDP) product has the richest formulary with the most adherence generics on Tier 1? - ✔️Value Plus Centene requires all contracted brokers/agents to read, understand, and agree to Centene's Business Ethics and Code of Conduct Policy. - ✔️True Communication of PHI can be: - ✔️Written, Electronic, Verbal From October 1 to October 14, certain activities are Non-Permissible Activities. These include: Assist with completing an application Collect a completed application Advise the beneficiary to complete an application prior to October 15. - ✔️All of these Member PHI can be stored on an external hard drive or a cloud storage service like Google Drive or Apple Cloud. - ✔️False Which option is the preferred method to submit enrollment? - ✔️Ascend Web/Mobile Application When discussing prescription drug coverage, you should: - ✔️Explain how to use the formulary to look up limitations and exclusions (e.g., step therapy, quantity limits). Confirm coverage of the beneficiary's current and/or anticipated prescriptions. Explain formulary tiers as well as drug copayment amounts.
✔️Express Scripts Pharmacy The beneficiary (or their authorized representative) must indicate the product types to be discussed during the appointment on the Scope of Appointment (SOA). - ✔️True Prior to the beginning of the enrollment process, a broker/agent is required to cover certain beneficiary specific information, including but not limited to: - ✔️All of these The Single Sign-On Portal provides access to several applications, including CustomPoint - ✔️True An SEP is a period outside of the ICEP, AEP, or MA OEP when beneficiaries can enroll based solely on life events that qualify for an SEP period. - ✔️True The Mastery Exam will lock for a period of 48 hours after each failed attempt. - ✔️False When an enrollment application is completed in Ascend, brokers/agents can complete a Health Risk Assessment (HRA) directly in Ascend after the enrollment application, through the Value-Based Enrollment (VBE) portal. - ✔️True Brokers/Agents MUST complete a Wellcare Contract Recertifi cation case in Centene Workbench (CWB) every two years. - ✔️False Brokers/Agents can submit a support ticket online through their Centene Workbench portal. - ✔️True Wellcare added which state to its footprint for 2024? - ✔️Delaware What are some examples of steps that can be taken when safeguarding and securing PHI and PII? (Select all that apply.) - ✔️Shred documents that contain PHI or PII using appropriate means. Never leave laptops, PHI, or PII in an unattended vehicle. Do not include PHI or PII in the subject line or body of an email. Secure emails that contain PHI or PII. Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task -
✔️True Marketing materials that have been developed by a third-party marketing organization (TPMO) for multiple MA organizations or plansmust be pre-reviewed by each MA organization, submitted to CMS in the Health Plan Management System (HPMS), and opted-in by thePlan prior to distribution. - ✔️True The Prescription Drug Plan (PDP) network is expected to include over ____ total pharmacies. - ✔️Sixty Thousand With which types of inquiries can Wellcare's Corporate Sales Support team assist? - ✔️All of these Which Prescription Drug Plan (PDP) product features no deductible on any tier? - ✔️Value Plus A request to the plan from a member or provider for a formal review of an Action (Denial) or Adverse Plan Determination (Medicare) is a/an: a. - ✔️Appeal Enrollments through Ascend off er the following unique benefits: - ✔️Validation of important data to help prevent incorrect or missing information Search for providers and formularies to validate physician and prescription availability Extra help eligibility status. Digital capture of the broker's/agent's and benefi ciary's electronic signatures through Send for Signature at any timethroughout the enrollment application. An LEP is assessed by CMS when a member goes ______ days or longer without creditable prescription drug coverage after they become Medicare-eligible. - ✔️63 days Members who have LIS and enroll in other plans will have a premium to pay regardless of the level of LIS the member is granted. - ✔️True Which standalone Prescription Drug Plan (PDP) is best for a dual-eligible chooser? - ✔️Classic Dual-eligible and LIS beneficiaries that are not at-risk may use a Dual-Eligible SEP once per each of the ______ calendar quarters only. - ✔️First, Second , Third A Health Risk Assessment (HRA) -
