1
What is the highest rating a Medicare plan can receive?
Answer: 5 Stars Mentor: CMS STAR RATING PROGRAM
What does PHI stand for?
Answer: Protected Health Information Mentor: HIPAA OVERVIEW
What tool should advocates use for call documentation?
Answer: Quick Start+ Mentor: Internal Documentation Rules and Standards Overview
What is the first authentication requirement?
A unique member identifier Mentor: HIPAA Job Aid Member or Individuals
What is our main mentor?
Medicare Advantage Prescription Drug (MAPD) Document Index
After how many consecutive years of poor performance does a plan receive a warning icon?
Answer: 3 years Mentor: CMS STAR RATING PROGRAM
Name one example of PHI.
Answer: Date of birth, address, phone number, Member ID, email address, etc. Mentor: HIPAA OVERVIEW
What is the mentor for Authentication?
HIPAA Overview
Who can add a password to a member account?
The member Mentor: Password Protection Overview
Are advocates allowed to ask for a member's Social Security Number?
No
Mentor: HIPAA OVERVIEW
Name one preventive service that can impact Star Ratings.
Answer: Annual checkup, mammogram, or glaucoma screening Mentor: CMS STAR RATING PROGRAM
What happens if an account has Password Protection?
PHI cannot be released without the password. Mentor: Password Protection Overview
What Mentor outlines the entire Medicare call process from greeting and authentication through closing the call?
Medicare Member Call Flow
How many authentication elements are required to authenticate a member?
3 Mentor: HIPAA Job Aid Member or Individuals
If a caller asks for a reference number for the call, what should be provided?
Interaction Number Mentor: Offer the Case or Interaction Number Overview
Which organization created the Five-Star Rating System for Medicare plans?
: CMS (Centers for Medicare & Medicaid Services) Mentor: CMS STAR RATING PROGRAM
What pharmacy mail-order service is promoted through Guidance Alerts?
CenterWell Pharmacy Mentor: Guidance Alert Overview
Name one example of an empathy statement an advocate can use.
“I hear you, that must be frustrating.” Mentor: Medicare Member Call Flow
If a member expresses frustration, what must be documented to remain CMS compliant?
The grievance details and G&A/Complaint fields.
Mentor: Medicare Member Call Flow
During a transferred call, CRM shows the caller is already authenticated. Do you need to authenticate them again?
No.
Mentor: Authenticate and Create an Interaction in CRM Genesys Softphone
Where can members view their Medicare plan ratings online?
STAR RATING CALLS
A member says they want to leave their current plan because of its Star Rating, but they don't know what plan they want. What is the next step?
Transfer to a Licensed Sales Agent (DMS). Do not offer a plan change.
Mentor: STAR RATING CALLS
A member's account is password protected. The member successfully authenticates but cannot provide the password. Can PHI be released?
No, PHI cannot be released without the password.
Mentor: Password Protection Overview
A member has multiple open issues and two separate cases remain open. Should you offer a case number or an interaction number?
Interaction Number.
Mentor: Offer the Case or Interaction Number Overview
A Guidance Alert was delivered successfully. How long will it generally remain off the member's account before it can display again if the member is still eligible?
120 days.
Mentor: Guidance Alert Overview