Apple
Which application is used to file an expediated grievance?
Ans-star central
What does the abbreviation SPAP mean?
Ans- State Pharmaceutical Assistance Program
What's the TAT for pre-service?
Ans- 14days
What is the TAT for materials sent through onekit?
Ans- 14 days
What is the TAT for address change?
Ans- 5-7 business days
Which document is generated a month after a claim is finalized?
Ans- EOB
Where would you go to locate the mbs MOOP amount?
Ans- accumulators
What 2 ways can an agent file an expediated appeal?
Ans- through star central or the quickbase
What is the standard timely filing timeframe for member reimbursements? Include the KA as well
Ans - 365 days (KA 2778)
Where in GPS can you find the amount the mbr is paying for LEP?
Ans- Premium & Payments- under details
During which election period can a mbr join, drop or switch their plan?
Ans- During AEP
Omnipod is covered under PART B (medical) only through certain circumstances? (True or False) Include the KA as well
Ans - False. Omnipod is strictly covered under PART D (pharmacy) KA 4368
How long does it takes to reflect the changes for COB?
Ans- 15 business days
How long after an auth is denied can a peer to peer be done?
Ans- 14 days
How long before a new Auth can be submitted once denied?
Ans- 60 days
When can OSB be added to a plan?
Ans- During AEP or within 30-31 days of their new enrollment or plan change.
What's the knowledge article number in which you can find the disclaimer for filing an expedited appeal?
Ans - KA 2825
List 2 services that falls under Prosthodontics and Maxillofacial services.
Ans- Crowns, Dentures( full or partial), implants and bridges
What is the name of the vendor that manages Home Health Services for members in select states? Include the KA
Ans- Carelon KA4390
Where can you check to see if OSB is added to the mbrs plan? Include the KA as well
Ans- Gps (premium & payment tab) and under the contact screen KA 3708
Name 3 examples of information you cannot share with a broker. Include the KA as well
Ans- The diagnosis code, procedure code or provider name on a claim, making an address update, email updates, changes in payments such as SWPWH or EFT changes (The account holder needs to be on the line), referral or other Precertification PHI, Information about medications on file in the member's account, accumulators, deductible or amount met toward OOP (KA 3018)
When the member states that they have not receive a cheque that was sent, however, after checking in HRP it shows where the cheque was cashed. After submitting a request to the task team to have them check the imaged pulled, how long after does it take for the member to get a response? Include the KA as well
Ans - 2 business days. KA 3274
If a member has a password on their account and they do not remember it, what is the process for the member to set a new password? Include the KA as well
Ans - They should send a letter requesting new password to be set. Include in the letter: Date of request, member's signature, the appropriate validation criteria needed to confirm the member's identity, the new password, tell the member to mail or fax the request to the HIPAA Member Rights Team. (KA 3130)
State the call types in which the verbal disclaimer must be used, along with the KA.
Ans- External- non-Aetna customer, Inbound, Outbound. KA 4194
Which entity is the PBM (Pharmacy Benefits Manager) for Aetna?
Ans- CVS caremark