UHC Certification Fast Track Practice Exam

These questions are part of the practice quiz. Start practicing

• What is the purpose of CPT modifiers in medical billing?
• Which of the following are eligibility requirements to enroll in a Medicare Advantage (MA) Plan?
• For a D-SNP member who loses Medicaid eligibility, when does the Special Election Period begin?
• A beneficiary with a Medicare Supplement Plan and a standalone Prescription Drug Plan seeks coverage for a chronic condition. Which plan could help manage this need?
• What are common reasons for duplicate claims, and how can they be prevented?
• Under an HMO, using out-of-network services generally results in what?
• Which statement about Extra Help is correct?
• What documentation is typically required to support a prior authorization request?
• What does SEP-Special Need/Chronic allow a beneficiary to do?
• What is the primary purpose of Dual Eligible Special Needs Plans (D-SNP)?
• What is the difference between a denial for 'not medically necessary' and 'not covered'?
• Which statement is true about how the loss of Medicaid affects a member's enrollment in a Dual Eligibility Special Needs plan (D-SNP)?
• What is the primary purpose of eligibility verification before providing services to a UnitedHealthcare member?
• If the enrollee has not resided in the contracted SNF for 90 days at the time of enrollment, which documents qualify as additional proof to be submitted to the enrollment department?
• Which activity is a provider participating in an agent's marketing/sales event permitted to do?
• What is a key purpose of a Dual Eligible Special Needs Plan (D-SNP)?
• How does a consumer who qualifies for Low Income Subsidy (LIS) receive financial assistance for their share of Medicare Part D costs?
• What is the minimum time separation between two events at the same venue?
• How are home health services typically coded and billed under UnitedHealthcare?
• Which factor influences how much members pay for their medications?
• Which statement best reflects the purpose of Permission to Contact guidelines?
• How does network adequacy affect member access to care?
• A 68-year-old enrolled in a Medicare Supplement Plan with a standalone Part D asks about a plan that will help manage a chronic condition. Can he enroll in a Chronic Special Needs Plan using his Special Election Period?
• Which statement most accurately distinguishes a grievance from an appeal?
• Under D-SNPs, when Medicaid is lost, which statement about cost-sharing applies?
• During a marketing event, which action is allowed when interacting with attendees?
• What is the role of medical necessity criteria in claim adjudication?
• Which statement best defines preauthorization?
• What is the purpose of tiered copays/coinsurance within a formulary?
• Which statement is true about the Medicare Advantage (MA) out-of-pocket maximum?
• Which statement is true about C-SNPs, D-SNPs, and prescription drug coverage?
• Which describes the standard process for payer assignment in coordination of benefits (COB)?
• Which privacy principle requires limiting access to PHI to the minimum necessary?
• When a consumer calls you after reading or hearing an advertisement, which statement is true?
• Which of the following is a compliant activity at an educational event?
• What must an agent do regarding lead cards at a formal marketing/sales event?
• What is remittance advice and why is it important for post-claim payment processing?
• What is the difference between professional fees and facility fees on a claim?
• Which statement accurately describes eligibility for enrolling in a Medicare Advantage Plan?
• Which of the following statements about offering food items at events is true?
• Which of the following is a comprehensive security control for protecting PHI?
• Which of the following must an agent obtain no less than 48 hours before the start of an in-person, online, or telephonic marketing appointment?
• How can providers maintain HIPAA compliance when transmitting electronic claims?
• The Chronic Condition Verification form/ questionnaire authorizes the plan to do what?
• How do quality measures and value-based programs influence provider payments?
• What qualifies an eligible consumer to use the Integrated Care SEP?
• What happens if timely filing is missed?
• Which statement accurately describes Late Enrollment Penalty timing?
• Which statement best describes eligibility to enroll in a standalone Prescription Drug Plan?
• Which professionals use the CMS 1500 form?
• Melanie wants to enroll in a D-SNP. Which of the following must her agent do?
• Which option also enables a consumer to obtain prescription drug coverage?
• What does the term maximum out-of-pocket (MOOP) represent in a health plan?
• What type of event is an agent conducting when they present plan information that includes benefits and cost-sharing in an audience-presenter format?
• A consumer with only Part A and living in the plan's service area can enroll in which plan type to obtain Part D coverage?
• Which event advertisement or invitation must include the disclaimer: 'For accommodation of persons with special needs at meetings, call'?
• Which document is used to record the scope of topics discussed during a marketing event?
• During Medicare Open Enrollment, which statement is true?
• What does the acronym PFFS stand for in the plan naming context?
• Which giveaway is not permitted at an educational or marketing/sales event (assume nominal value if allowed)?
• Which of the following statements about the 5-Star Special Election Period (SEP) is true?
• What documentation is typically needed for prior authorization of a high-cost DME item?
• Which statement is true about UnitedHealthcare Medicare plans carrying the AARP name?
• Which coverage is included in C-SNPs and D-SNPs?
• What happens when a member meets the MOOP during a policy year?
• Which item is least likely to be required to support a prior authorization request?
• What is the purpose of patient entitlement verification tools in UHC?
• Select the option that accurately represents Medicare Advantage (MA) Plan Network characteristics for non-emergency care.
• Before completing an enrollment application, which items must an agent review with the consumer?
• Which statement describes a feature of D-SNPs?
• To avoid being at the venue at the start of a planned marketing/sales event that is canceled, what must the agent do?
• Which statement best describes out-of-network benefits in UnitedHealthcare plans?
• Which advertiser disclaimer must be included for accommodations at events?
• How does coordination of benefits (COB) determine which payer pays first?
• Why is a PCP referral often required for specialist services under HMO plans?
• Which election period allows enrollment in a Chronic Special Needs Plan for someone with a chronic condition?
• If a beneficiary loses Medicaid eligibility, which cost-sharing components might apply under the plan?
• Which statement describes a Medicare Advantage eligibility condition?
• Chronic Special Needs Plans are designed for which group?
• Ginny just enrolled in a C-SNP that uses the post-enrollment verification method. When will the plan send her an initial notice of termination if it has not yet been able to verify a qualifying chronic condition?
• Which statement is true about Medicare Supplement Open Enrollment?
• What is the purpose of the Medicare Advantage out-of-pocket maximum?
• What action should be taken if a service is non-covered by a payer?
• Which statement is true of D-SNP members?
• What are common security controls for protecting PHI in UHC operations?
• Which form is used to bill facility charges in a hospital setting?
• By agreeing to the statement of understanding, what does the consumer acknowledge?
• What is the difference between an internal and an external appeal?
• Which statement accurately describes a prescription drug stage?
• What is subrogation in health insurance?
• Sam has an educational event scheduled at the public library on Tuesday, October 17 from 10-11am. The library is open daily from 9am-8pm. When is the earliest he can conduct a marketing, sales event at that library?
• Which of the following statements is true about Medicare Supplement Insurance underwriting criteria?
• For Chronic Special Needs Plan enrollment, what is true about the provider named on the verification form?
• Which statement is true about Extra Help for LIS qualifiers?
• Which statement about Medicaid is true?
• What is the difference between preauthorization and concurrent review?
• Which practice reduces exposure of PHI when transmitting electronic claims?
• Which statement about the Medicare Coverage GAP is true?
• When may a marketing/sales event be conducted at a venue that serves a meal as part of its daily activities (e.g., senior center, soup kitchen)?
• Which giveaway is not permitted at an educational or marketing/sales event (assume nominal retail value is met)?
• What defines an ERA and how does it differ from a paper remittance?
• To complete an Enrollment Application on behalf of a consumer, what authority must the individual have?
• What is the required lead time before a marketing appointment for Scope of Appointment (SOA)?
• What is the maximum per-person value allowed for a meal plus giveaways at an educational event?
• Which scenario aligns with SEP-Special Need/Chronic eligibility?
• How should a provider handle a erroneous payment or overpayment by a payer?
• What are common denial scenarios related to coverage and eligibility, and how should they be addressed?
• Which statement describes the purpose of Utilization Management Rules in prescription drug plans?
• Which statement accurately describes a formulary?
• What does an Explanation of Benefits (EOB) communicate?
• Which type of event allows offering meals under a per-person cap, according to the rules for educational events?
• To allow ample time for UnitedHealthcare to process the cancellation in the event reporting application, when should Tori submit a Cancel Event Request Form?
• What is a prior authorization denial and how should providers respond?
• Which statement about Special Election Periods is true?
• Which statement best describes an internal appeal?
• Which two code sets are used to categorize diagnoses and procedures in billing?
• What is step therapy in pharmacy benefits?
• How do in-network benefits differ from out-of-network benefits with UnitedHealthcare?
• What type of financial assistance does Low Income Subsidy (LIS) provide?
• What are the reasons a consumer can use the Special Election Period for Special Need/Chronic?
• A late enrollment penalty (LEP) may apply if a consumer did not enroll in a Medicare Part D plan when first eligible or lacked creditable prescription drug coverage for how many continuous days?
• What information should be included in a payer inquiry when a claim is denied?
• Which scenario represents a permissible plan combination for a consumer as described in the material?
• During the grace period after Medicaid loss, what is true about cost-sharing?
• Which statements about drug utilization management (UM) rules are true?
• What is the typical coverage stance on telemedicine visits under many UnitedHealthcare plans?
• Why is accurate date of service and place of service coding important?
• What does the term service area refer to in Medicare Advantage plans?
• What is timely filing in medical claim submission?
• What kind of financial assistance does a consumer get if they qualify for Low Income Subsidy (LIS)?
• Which statement accurately describes UnitedHealthcare's requirement for reporting marketing/sales events prior to advertising?
• When does Medicare Supplement Open Enrollment occur?
• Which statement about Integrated plan enrollment is true?
• Which statement describes the Catastrophic Coverage stage in Part D?
• Which two consumers can use the Special Election Period 'SEP-Special Need/Chronic'?
• Which statement describes network provider services in an HMO plan?
• What is a formulary, and how does it affect prescription benefits?
• Which of the following is not considered prohibited unsolicited contact with a Medicare eligible consumer according to CMS regulations AND UnitedHealthcare's rules, policies, and procedures?
• Which statement best describes how to handle plan benefits mentioned in an advertisement?
• Which election period specifically enables a Full Dual-Eligible consumer to enroll in an Integrated D-SNP?
• What is the per-person value limit for meals and bundled items at events?
• What does a 2-star rating indicate for a Medicare plan?
• When would UB-04 be used instead of CMS 1500?
• What is the role of claim control numbers in the adjudication process?
• Which entity reviews an external appeal?
• Which term describes the maximum limit on a member's annual costs for Medicare-covered services in a Medicare Advantage plan?
• What is the purpose of the Late Enrollment Penalty (LEP)?
• When selling D-SNPs, agents must...
• Which types of events must include the accommodation disclaimer 'For accommodation of persons with special needs at meeting, call'?
• If a Power of Attorney (POA) signs the Enrollment application, what must the plan be able to provide upon request?
• What is the effect of an NCCI edit?
• Janet is conducting an informal marketing/sales event at her local soup kitchen. When speaking to the Activities Director, lunch is served daily from 11:00 AM-1:00 PM. Which of the following is a compliant time when Janet can host her event?
• What is a Grievance in UHC, and how does it differ from an Appeal?
• What type of event is an agent conducting when they inform Medicare consumers only about Original Medicare, Medicare Advantage, Prescription Drug, or other Medicare programs?
• Select the option that describes the rule about conducting a marketing/sales event following an educational event.
• Why are NCCI edits important in medical coding?
• Which describes Permission to Contact (PTC) guidelines?
• Which services commonly require prior authorization in UnitedHealthcare plans?
• Who is primarily responsible for coordinating care and ensuring medical necessity for specialty services in an HMO?
• Which of the following best describes eligibility requirements to enroll in a Medicare Advantage (MA) plan?
• What are best practices for handling member appeals and provider communications to improve outcomes?
• When conducting an informal marketing/sales event, agents may__________
• What is generally required to ensure telemedicine coverage under plans?
• Which statement best reflects translation accessibility at formal marketing events?
• Within what timeframe do C-SNP pre-enrollment verifications need to be completed before an enrollment request is denied?
• Which statement best describes the purpose of remittance advice for post-claim processing?
• Which statement correctly matches the code set to its purpose?
• What is the primary purpose of provider enrollment and credentialing with UnitedHealthcare?
• Jared is planning a formal marketing/sales event for October 24. While it is strongly recommended that Jared reports his event at least 14 calendar days in advance, what is the last date the Event Request Form can be submitted to UnitedHealthcare?
• What is a 277CA in the claim process?
• Step Therapy, Prior Authorization, Quantity limit, 7-DAY limit, Dispensing Limit and Limited Access are all examples of what?
• Which item is not typically required for prior authorization of a high-cost DME item?
• Which combination of plans could a consumer have together according to the material?
• Which entity defines guidelines for prohibited unsolicited contact for Medicare plans?
• In states where Medicare Supplement underwriting applies, which statement is true about underwriting?
• Which statement best describes access to providers for some C-SNPs?
• Do consumers have to be an AARP member to enroll in an AARP-branded plan with UnitedHealthcare?
• Which statement best describes the Late Enrollment Penalty (LEP)?
• How should eligibility data be updated when coverage changes mid-treatment?
• Which option will enable a consumer to obtain prescription drug coverage?
• If a Medicaid eligible member loses eligibility, what is a valid path to enroll in a plan?
• How do ICD-10-CM diagnosis codes differ from CPT codes?
• How do dental or vision benefits typically differ from medical benefits in UHC billing?
• Which statement is true about election periods?
• Which plan type specifically identifies as a Dual Eligible Special Needs Plan?
• What is the likely impact of accurate date of service and place of service coding on claim outcomes?
• Which statement about Medicaid is true?
• Which guidelines do you keep in mind when you hear a consumer mention a plan benefit from an ad?
• Who develops a formulary for a Medicare plan?
• If a Dual Eligible Special Needs Plan member loses Medicaid eligibility, what happens to their D-SNP enrollment?
• At an educational event, what activity is an agent allowed to perform?
• If an event is canceled, which action must be taken for RSVP'd attendees?
• How should a provider respond to a request for additional medical necessity documentation after claim submission?
• Which statement accurately describes reporting for canceled marketing/sales events?
• Which statement best describes D-SNP eligibility?
• How can patient cost-sharing amount estimates aid in financial counseling?
• Which of the following is not considered prohibited unsolicited contact with a Medicare-eligible consumer according to CMS regulations and UnitedHealthcare policies?
• Of the election periods listed, which one can Full Dual-Eligible consumers use to enroll in an Integrated D-SNP in JULY?
• Which statement about in-network benefits is correct?
• What is the purpose of benefit maximums and how can they affect reimbursement?
• 837P and 837I formats are used for which claims?
• When a consumer calls you after reading or hearing an advertisement, what is another important consideration?
• Which statement best describes professional versus facility claims processing in UnitedHealthcare?
• What is Scope of Appointment?
• Which statement about underwriting and Guaranteed Issue is true?