2025 Elevance Risk Prevention

There are differences among fraud, waste, and abuse. One of the primary differences is ________ and knowledge.

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.

You MUST tell your PPO plan clients they will have to pay more when seeking non-emergent eligible services outside of the network.

You receive a questionnaire regarding a sales misrepresentation inquiry. You must respond within the designated time frame, addressing all concerns in the allegation and include any pertinent notes from your sales appointment, event, etc. that may apply to the allegation.

You MUST EXPLAIN the Part D late enrollment penalty.

CMS will allow Third-Party Marketing Organizations (TPMOs) to continue sharing a beneficiary’s data as long as they obtain prior express written consent through a clear and conspicuous disclosure for each TPMO that will receive the beneficiary’s data and contact them.

In this module, which of the following terms do NOT refer to a single occurrence of marketing misrepresentation?

Which of these activities would NOT be classified as marketing misrepresentation?

Agents/Brokers are allowed to offer gifts as a condition of enrollment.

Agents are permitted to call former members who have voluntarily disenrolled or current members in the process of disenrolling to market plans or products.