GPS
What is the Resources for Living program?
It's a program that helps connect members and caregivers with resources in their community
How many level appeals do we have?
5
What benefit does a bone density test fall under?
Bone Mass Measurement
Give an example of an appreciation statement
Thank you so much for allowing me to assist you today or Thank you so much for being the BEST part of AETNA.
What is LIS & who can we transfer the mbr to for LIS assistance?
Low Income Subsidy (also referred to as Extra Help)
Benelynk
GPU for FL mbrs
Does Medicare cover newborn care?
NO
What is a CTM?
Complaint to Medicare or Call to Medicare
What system do we use to look up authorizations?
Medcompass
What are the PEAS in QUEST?
Paraphrasing, Empathy, Appreciation, Summarize
What is the policy when making a FL pcp change?
All changes must be made for the 1st of the following month?
What benefit would a wheelchair fall under?
DME
What is a Coverage Determination?
Prior authorization related tp Part D
Where in GPS can you see the Max out of pocket?
Accumulators
Why do we paraphrase?
To make sure that we FULLY understand why the member is calling?
Dr Ian Tucker
24 Battle St Ste 1A
Somers, CT 06071
What is his role here with aetna?
PCP/Family Practice
If a member's benefit show exclusive for diabetic supplies what brand are they allowed to get that would be covered at 100%
Aetna brand only----One touch/Life scan
What is the turnaround time for a standard appeal pre-service for Aetna to make a decision?
30 calendar days
What two systems do we use to verify if a provider is participating with the member's plan or not?
SFE & RUMBA
What system will you use to view grievances, appeal, CTM?
Medhok
Does Dr. David Roth accept the Aetna Medicare HMO POS plan?
Yes
If a member is needing to get their toenails clipped and have corns and calluses removed what benefit would that fall under?
Routine podiatry
What is the turnaround time for a standard authorization pre-service for Aetna to make a decision?
14 calendar days
What is the TAT for a standard grievance resolution?
30 days
How do we greet our callers?
Hello, my name is _______ am I speaking with the member? May I have your member ID?
or
Hello, my name is ________ may I have your member ID?
What is the nation benefits card used for?
What is the healthy rewards program?
Healthy Foods, Utilities, Gas, Phone Bill, Mortgage or Rental assistance.
It's a program where mbr's complete activities and receive GC's for the activities completed