Anthem - Risk Prevention %ACCURATE

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If a beneficiary currently has drug coverage through another carrier, you must verify their prescriptions would be covered under our plan's formulary, too. The drugs that are actually covered may vary... from one carrier to another or one plan to another. - ANS -True You MUST tell your PPO plan clients they will have to pay more when seeking non-emergent eligible services outside of the network. - ANS -True You receive a questionnaire regarding a sales misrepresentation inquiry. The questionnaire regarding the complaint must be completed and returned promptly. When must you return your response? - ANS -Within 48 hours You MUST EXPLAIN the Part D late enrollment penalty. - ANS -True Not all providers are contracted to serve as a primary care physician (PCP). Use the online tool to find/verify the PCP indicator information. - ANS -True If a beneficiary wants you to hold an enrollment form/application, you must explain that you can either submit or cancel the enrollment form/application following established procedures. - ANS -True Agents are permitted to call former members who have voluntarily disenrolled or current members in the process of disenrolling to market plans or products. - ANS -False Provider Networks may be accessed through what methods? - ANS -Both A and B may be used When a beneficiary is trying to decide between plans during a sales appointment, it is okay to omit information critical to the beneficiary if they don't ask pointed questions. - ANS -False Documents with beneficiary information (such as withdrawn, incomplete, or incorrect applications, or records at the end of the required retention period) must be properly disposed of via cross cut shredding and NOT reused or placed into regular recycling or trash containers. - ANS -True Agents/Brokers are allowed to offer gifts as a condition of enrollment. - ANS -False What does the Allegations process allow the plan to do? - ANS -All of the above statements are correct [Show More]

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