Virginia Assessment 3

1.

1 point

Is this statement true, Uniform Assessment Instruments are sent to both Humana and the State for updates and it can be earlier than the actual enrollment?

True

False

2.

1 point

Which of the following systems can be used to determine eligibility and discharge dates?

Clinical Guidance Exchange, Marx, State System and Healthnet

Clinical Guidance Exchange, Ecare, State System and Enrollment mailbox

Market Prominence, Ecare, State System and Enrollment mailbox

Clinical Guidance Exchange, Ecare, State System and Healthnet

3.

1 point

Program administered by the State that serves low-income individuals who are elderly and/or live with disabilities and works to ensure their health, safety, and welfare is known as a Waiver.

True

False

4.

1 point

A Nursing Facility or NF is a Waiver Code 2, is this statement true or false?

True

False

5.

1 point

Community Well/Non Waiver (BSN 001) will display a null value on the 834.

True

False

6.

1 point

When a member has a 'Missing in Vendor' discrepancy this means that member is not 'active' in CI; when a member has a 'Retro Missing in Vendor' discrepancy this means that member has never been in CI.

True

False

7.

1 point

A Skilled Nursing Facility (SNF) is a type of nursing home recognized by the Medicare and Medicaid systems as meeting long term health care needs for individuals who have the potential to function independently after a limited period of care.

True

False

8.

1 point

What does PIRS stand for?

Patient Internal Rating Summary

Patient Individual Rating Surveywaiver code

Patient Intensity Rating Survey

Patient Independent Rating Summary

9.

1 point

What are the two Medicaid Rate Cell Categories for VA Duals?

Community Facility Care and Nursing Home Care

Community Well and Nursing Facility Level of Care

None of the above

Community Care and Waiver Care

10.

1 point

BSN 001 ties to an EDCD Waiver plan.

True

False

11.

1 point

What system would house eligibility data for NF (Custodial Care/EDCD) stays?

Ecare

State System

Enrollment Mailbox

Clinical Guidance Exchange (CGX)

12.

1 point

Member is on a Waiver plan for 8/1/2015
State System displays a Waiver start date of 8/12/2015
Member should be on Waiver plan
Humana should receive Community Well payment for the month of August

True

False

13.

1 point

Associate will need to determine the member's true eligibility date if member is on a Waiver plan and Humana receives a Community Well rate

True

False

14.

1 point

Always look to the TranDate and not the Cover Begin Date when looking for variance month that is in question.

True

False

15.

1 point

What does the 'C' transaction type mean and why would this come on the 834?

Change, mbr termed

Current, DOB updated

Change, DOB updated

Current, mbr termed

16.

1 point

If a Care Change has taken place what is the time frame in which a PIRS form has to be completed and submitted to DMAS?

2 weeks

60 days

2 months

1 week

2 days

17.

1 point

For Waiver Hierarchy, what is the correct source order starting from most important to least?

UAI & PIRS, Market & DMAS, 820 & 834 and USER

USER, UAI & PIRS, Market & DMAS and 820 & 834

USER, 820 & 834, Market & DMAS and UAI & PIRS

Market & DMAS, 820 & 834, USER and UAI & PIRS

18.

1 point

Is this statement true, UAI is completed 1x unless the member loses eligibility or has a break in services?

True

False

19.

1 point

Virginia Dual plan is ____ plans working together as one to offer the member the best coverage possible under the ______ and _______ program

20.

1 point

When an Enrollee's income is under an allowable amount, he or she must contribute toward the cost of their LTC services. This contribution is known as the Patient Pay amount.

True

False

21.

1 point

What platform are NF/Waiver claims paid on?

Humana

ILS

LTSS

None of above

22.

1 point

Member is on a Waiver plan for 3/1/2015
State System displays a Waiver start date of 3/9/2015
Member should be on Waiver plan
Humana should receive Community Well payment for the month of March

True

False

23.

1 point

What does EDCD stand for?

Elderly Disabled Costumer Database Care

Elderly Disabled Costumer Department Care

Elderly Disabled Consumer Directed Care

Elderly Disabled Consumer Department Care

24.

1 point

If the member was previously eligible for waiver / LTC services prior to enrolling with Humana we can not use the UAI and DMAS 99 form to determine eligibility.

True

False

25.

1 point

If the LTSS screen shows USER as the source code should you do research to find the true source of the waiver status?

Yes, you should always do research to find the true source of the waiver code.

No, you should never do research to find the true source of the waiver code.

Yes, you should do research to find the source code if there is no end date on the LTSS screen

No, you should not do research if the member has an end date on the LTSS screen.

Both C & D

26.

1 point

If member is not NEWLY eligible but is enrolled w/Humana in a waiver status, the Premium Recon team will use the Physician's signature on the UAI to calculate expected rates.

True

False

27.

1 point

State provides an approved ____ ____ that corresponds to the Plan Benefit structure (Group/BSN)

28.

1 point

In scenario 2, the mbr was ____

newly enrolled on 02/01/2015 with eff date 02/01/205 and termed on 7/30/2015 for end date of 07/31/2015

waiver eligible 12/01/2014

added on 11/19/2014 as HCBS and then changed to LTC on the 1/24/2015 Full File

active the entire month of July

29.

1 point

The State of Virginia refers to the VA Dual plan as

Commonwealth Coordinated Care (CCC)

Medicare Medicaid Plan (MMP)

Dual Demo (Medicare Medicaid Plan)

Medicare Medicaid Aligned Initiative (MMAI)

All the above