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What will happen if a member opts to use a different mail-order pharmacy other than Express Scripts pharmacy?
A. The member's medication will still be covered by the plan.
B. The member cannot use another mail order pharmacy.
C. If the mail order pharmacy is a network pharmacy, the member will pay standard cost sharing. If the MO is out of network, the member will pay out of pocket.
C. If the mail order pharmacy is a network pharmacy, the member will pay standard cost sharing. If the MO is out of network, the member will pay out of pocket.
True or False: All new and existing members will receive a new ID Card for 2024.
A. True
B. False
A. True
Alexa didn't receive an ID card and called customer service to check if her plan is active. Upon accessing the member's account, you see the application is in pending status. How can you assist?
A. Advise that you will connect the call to MET to complete the application.
B. Check the reason the account is in a pending status. Confirm with the member if she can provide the missing information. Follow Care Connects and submit the missing information in MEPs.
C. Provide the Id number and advised it will be completed in 1-2 business days.
B. Check the reason the account is in a pending status. Confirm with the member if she can provide the missing information. Follow Care Connects and submit the missing information in MEPs.
Ana was using CVS Caremark for her mail order prescriptions previously. She wants to switch to Express Scripts. How would you assist her?
A. Check to see if she remaining refills on her prescription with CVS. If she has no refills left, she needs to obtain a new prescription and submit it to Express scripts.
B. Contact her doctor to let them know that she will be using Express Scripts moving forward.
C. Provide the options on how to contact Express scripts.
D. All of the above
D. All of the above
If the member obtained the initial fill for a non-covered medication under the TOC policy, what should the member do to obtain succeedging refills?
A. Discuss alternative with their doctor.
B. Submit a coverage determination.
C. Pay full price
D. Answers 1 and 2 are correct
D. Answers 1 and 2 are correct
What will happen if a member doesn't use the new ID card for 2024 when filling prescriptions next year?
A. The member can still get the medication sine the ID number didn't change
B. The member's claim will be denied since it would be processed using the old pharmacy processing information
C. Member will have an additional copay for prescriptions
B. The member's claim will be denied since it would be processed using the old pharmacy processing information
Existing members will not be eligible for TOC.
A. True
B. False
B. False
True or False: All members are required to use Express Scripts mail order for their prescriptions.
A. True
B. False
B. False
True or False: It is a new member's responsibility to help themselves understand their own plan benefits and they should not contact us for any questions.
A. True
B. False
B. False
John enrolled in a Value Script plan for the year of 2024. He can't believe that his premium will be $0 even though he is not receiving Extra Help. How would you assist him?
A. Advise that he should not worry about it and that Value Script plan on the best plan for him.
B. Confirm the member's premium amount be transparent about the other potential costs, such as copays, co-insurance, or deductibles and set realistic expectations.
C. Congratulate the member for having a $0 premium plan.
B. Confirm the member's premium amount be transparent about the other potential costs, such as copays, co-insurance, or deductibles and set realistic expectations.
True or False: If the claim was denied due to incorrect processing information, you can contact the local pharmacy on the member's behalf to reprocess the claim using the new Pharmacy Processing Information for 2024.
A. True
B. False
A. True
During the first 90 days of the plan year, newly enrolled members are eligible for a transition fill. What is the maximum quantity allowed for this initial prescription fill?
A. 30 days' supply
B. 90 days' supply
C. 100 days' supply
A. 30 days' supply
What do you call the process when auto-assigned members don't want to accept their enrollment to Wellcare and wish to cancel their enrollment?
A. Affirmative Decline
B. Disenrollment request
C. Cancellation of Enrollment
A. Affirmative Decline
What actions would you take if the member is advising that they will file a complaint because of the cost difference?
A. Explain the difference in the cost and offer options to the member. If the member is still upset, escalate to MET.
B. Advised the member that you will call them back with a resolution.
C. Transfer to the pharmacy help desk to get clarification to the medication cost.
A. Explain the difference in the cost and offer options to the member. If the member is still upset, escalate to MET.
Jenny called customer service because she received a letter stating her application is incomplete. You checked the member's notes and found a RFID code in the notes. What does this mean?
A. Missing Date of Birth (DOB)
B. HICN not found
C. Missing Gender
B. HICN not found
How would you assist the member who is reposting a copay discrepancy? Select all that apply:
A. Empathize
B. Verify Information
C. Explain plan details
D. Offer Solutions
E. Maintain professionalism
F. Escalate if necessary
All of the above
What is the significance of making new members feel welcomed? Select all that apply
A. Member Satisfaction
B. Understanding Benefits
C. Reducing Barriers to Care
D. Member Retention
all of the above
Christina called on 1/5/2024 asking f she can cancel her plan with Wellcare. Her plan effective date was 1/1/2024. How would you assist her?
A. Advise Christina that since the plan is active already, she will need to submit a disenrollment request if she doesn't want to stay with Wellcare; and that she will be able to disenrollment if she has a valid SEP.
B. Advise that you can process the request and it would take 10-14 days to be completed.
C. Advise that she can cancel if she has a valid SEP.
A. Advise Christina that since the plan is active already, she will need to submit a disenrollment request if she doesn't want to stay with Wellcare; and that she will be able to disenrollment if she has a valid SEP.
Who can auto-assign members to Wellcare?
A. SSA
B. CMS
C. Department of Insurance
B. CMS
Cindy called customer service on 1/5/2024 and asked why she hasn't received her new card yet. She asked if she could still use her old card. How would you respond?
A. Advise that she can still use her old card since it has the same ID number.
B. Acknowledge the member's concern. Check to see if we mailed the new ID card and if we mailed it to the correct address. Request an ID card to be sent as needed.
C. Advise that she can print a temporary ID card from the website after she creates an account. Provide the new pharmacy processing information to Cindy.
D. Answers 2 and 3 correct
D. Answers 2 and 3 correct