Quiz # 4

If a provider is not listed in the SSC as either in-network or out-of-network, what can you do to resolve this? (Choose all that apply)

• Tell the customer you cannot verify that particular doctor but will be happy to verify others.

• Let the customer know they can call their doctor to confirm that they are in the network.

• Use the provider website listed in the Carrier guide to verify if they are in-network.

• Reach out to Infosource to verify if they are in-network.

During the MA-OEP a participant enrolled in an MAPD can... (Choose all that apply)

• Switch to Original Medicare only.

• Switch to Original Medicare and a PDP.

• Switch to another MAPD.

• Switch to another MA-only.

Upon discovering that a provider is not listed in the SSC, what should your next step be before anything else?

• Open the carrier guide to see if a link to a provider web search tool is provided.

• Chat infosource.

• Open the client guide to see if they have any special procedures for ignoring network restrictions.

• Search the funding guide to see if the participant(s) can afford to go out of network.

The AEP stands for...

• Annual Election/Enrollment Period

• Annual Elderly Placement

• Additional Enrollment Plan

• Additional Election Period

The following are types of Medicare Advantage plans... (Choose all that apply)

• PFFS

• HMO/HMO-POS

• PPO

• Cost

• Medigap

Medicare Advantage plans replace Original Medicare and usually utilize a network of doctors and hospitals to manage care.

• True

• False

Medicare Supplement (Medigap) plans replace Original Medicare and usually utilize a network of doctors and hospitals to manage care.

• True

• False

What are good resources to use to find out if providers are in network while you are on a call with a participant? (Choose all that apply)

• Carrier Guide

• Infosource

• SSC should have most providers listed automatically

• Client Guide

• Funding Guide

When talking to a participant, you should always make sure to... (Choose all that apply)

• Review the notes

• Set expectations

• Be respectful and patient

• Let them know if you're going on break soon and transfer them if your break interrupts the call

A participant must have Medicare parts A and B in order to enroll in the following plans... (Choose all that apply)

• Individual Dental plans

• Individual Vision plans

• MA/MAPDs (HMO, HMO-POS, PFFS, PPO)

• Medigap Plans (A, C, F, G, K, L, N, etc.)

• Stand alone drug plan