Service with HEART
What does HEART stand for ?
H - Helping / Efficiency
E - Engagement/Experience
A - Advocacy/Accuracy
R - Resolution/Responsibility
T - Trust/ Compliance/Privacy
What is the name of the list that has all dental codes in the EOC ?
Dental Schedule of Benefits
What KA gives you the numbers to all needed departments ?
KA 2621
What is a grievance ?
A grievance is an expression of dissatisfaction
If the code was given, where would you be able to see if a prior authorization is needed ?
NPL tool
What the closing we should say when on the call ?
Thank you for being the best part of Aetna or Thank you for calling Aetna Member Services
How many plans are listed for the 2026 Individual Dental Plans ?
21 Plans
What KA talks about Life station and how it works ?
KA 4489
What is the timeframe for a grievance to be filed ?
60 days but for FL it is 365 days
What tool should you should when looking to see if equipment would be covered ?
Durable Medical Equipment Reference List.
What are all the 1pt bonuses your able to get on a call ?
Exceptional Caller Comment, Exceptional PCS Comment, Business Initiative/Optimizing Technology, and Next Best Action (NBA)
What is the phone number for the dental providers to call ?
(800) 624-0756
Which KA talks about the TOC form and it states in the KA services that were performed after January 1, 2024 ?
KA 4246
What members file and inquiry instead of a grievance ?
Terminated, Cancelled/Voided, and Future Effective Date Members
Where can we check to see who a broker is for the member ?
Broker look up tool
What are four things you do when a call comes in ?
Open the call within 10 seconds, greet the caller, identify yourself, and offer assistance
What states use Liberty Dental for 2026 ?
FL, NY , NV , and OK
What KA talks about activities that would be under investiagation ?
KA 2612
If a member has a grievance about Part D, what should you ?
First help with any concerns about their medical coverage. Then, warm transfer the member to Part D and explain that they need to submit a grievance.
What tool do you use when looking to see if a provider status with the Aetna network ?
Provider Termination Repository
What is the current tip of the week in the Service with HEART hub ?
Thank You Statement
A meaningful thank you goes beyond the words "thank you" by explaining why you appreciate the person. Personalizing your gratitude helps create a more positive and memorable experience.
Is code D6104 dental in nature or medical in nature and what is the description ?
Dental in nature, Bone graft at time of implant placement
What is the newest KA ?
KA 14133
What are two reasons the member can file an expedited grievance ?
The member disagrees with our refusal to grant a member’s and/or a provider's request for an expedited organization determination or an expedited appeal and The member disagrees with our decision regarding an extension relating to an organization determination, or an appeal.
What tool would you use to see what instances a procedure would be covered ?
Total Payment Solution