Health Plan
HIPAA and PHI
HP Verification
FEP in MMIS
PCC Plan
100
What are the different ways an individual can enroll in a plan after being determined eligible for MassHealth? There are 4 ways
Online Mail Fax Phone
100
HIPAA stands for:
Health Insurance Portability and Accountability Act
100
Verification helps contact CSRs by doing the following.
Looking for 4 responses
Ensures that the person the CSR is talking to is who they say they are.
Confirms the caller is entitled to the information being discussed or requested.
Protects member personal information per HIPPA
Avoids fraud
100
There are no exceptions to the Fixed Enrollment Period. True or False
False
100
Which two plan types require you to select a PCP or Site at the time of enrollment?
ACOB and PCCP
200
What is the timeframe of the annual Plan Selection Period?
90 days
200
True or False
HIPAA and PHI policies are confidential and may only be viewed by supervisors.
False
200
If a head of household or member is calling about their own account, how many pieces of information does a CSR need to verify?
Three
200
How long does the Fixed Enrollment Period last for?
9 months
200
In MMIS What icon do you click on to look up a plan for the member's area?
Magnifying glass
300
A member has ____ days to choose a health plan once they've been approved for MassHealth.
14
300
Who is required to follow HIPAA policies and procedures? Name 2
Call Center Customer Service Representatives
Health Care Providers
300
If the caller is calling on behalf of a member, how many pieces of information does a CSR need to verify?
Four
300
Which plan type does NOT have a Fixed Enrollment Period?
PCCP
300
When can a member change from their PCCP plan to a different plan type?
At any time without exception
400
What is the health plan that is owned by MassHealth?
PCC
400
PHI stands for:
Protected Health Information
400
True or false? A member 18 years old or younger who is not a head of household cannot be talked to.
True
400
Members enrolled in a Primary Care Clinician (PCC) plan can change their health plan to an ACO or MCO plan at any time during the year. True or False
True
400
True or False: Primary Care Clinicians will submit a referral to MassHealth for the PCC plan members if they have a need to go to a specialist.
True
500
Based on the image below, which MassHealth coverage type has the lowest level of coverage?
Family Assistance
500
When serving customers for MassHealth, which becomes PHI? (Select all that apply)
Name
Address
Date of Birth
500
Which system should a CSR use to verify a head of household calling on their own behalf?
MMIS
500
Members enrolled in a MCO or ACO are not allowed to change their health plan during their Fixed Enrollment Period unless the member: Looking for 3 responses
Is a child or youth who is in the care or custody of the Department of Children and Families (DCF) or the Department of Youth Services (DYS).
• Is a newborn or child who is younger than one year old.
• Meets a Fixed Enrollment Plan exception.
500
Who is eligible for the PCC Plan?
Members under age 65 without third-party liability (TPL) in the following MassHealth coverage types are eligible to join the PCC Plan: o Standard o CommonHealth o CarePlus o Family Assistance