GPS
This is where you can search for Provider Participation in GPS.
Date of Birth, Email Addresses, and Medical Records are all examples of this.
What is Protected Health Information (PHI)?
When a member expresses dissatisfaction about any aspect of the operations, activities, or behavior or a Medicare Health plan (or its providers) - and it CANNOT be labelled as an Appeal or Organizational Determination - this will be filed.
What is a Grievance?
Member states they are on dialysis and are Medicare eligible because of this medical condition.
What is ESRD?
This is used to impersonate member's secure online account.
What is IAM Portal?
This is what you would select to find the Accumulators in GPS.
This form officially allows a specific caller that is not the member to discuss appeal information with Aetna.
What is an Appointment of Representative (AOR) form?
This is how an ESA Plan can be described to members.
What is: "The ESA PLAN works as if every doctor is in-network, in terms of copay. Same share cost as in-network!
The Provider ( Hospital or doctor's office ) HAS to accept 3 Key Features:
1. They must accept Medicare
2. They must be willing to treat the member
3. They must be willing to receive payment from Aetna
- They don't have to be in network with Aetna to receive payment from Aetna. We WILL pay them even if they're out of network."
A handbook that all Medicare eligible members receive.
What is the Medicare and You Handbook?
This resource gives info about the provider and used to get provider's participation.
What is Smart Front End or RUMBA?
This is where you navigate to find the EOC/SOC or Formulary in GPS.
What is Policy Name -> Health Policy Documents?
This is a legal document that allows another person to discuss and make decisions on behalf of the member.
What is a Power of Attorney (POA) form?
Resources for Living can assist a member in finding these kinds of resources.
What is: "RFL Consultants can also help Non-SNP members with the following types of programs:
• Adult daycare programs
• Assisted living facilities
• Caregiver consultation and support
• Emergency response systems (When the member does not have LifeStation benefits)
• Home Cleaning Agencies
• Food aid (Meal and grocery delivery)
• In-home care agencies
• Local senior activities/community services
• Local senior centers
• Nursing homes
• Pet care
• Senior housing
• Senior living options
• Support groups (Alzheimer’s, grief, etc.)
• Education materials on diverse topics
• And much more"
Eligible members will have a Medicare card described as this.
What is red, white and blue?
This is used to create letters such as: Disenrollment Forms or Compliance Letters.
What is OBC Plus?
This is where you navigate to verify the MBI via GPS.
What is Policy Name -> View Medicare Attributes -> Medicare ID?
This is the acronym for HIPAA.
What is the Health Insurance Portability and Accountability Act?
These are the qualifying activities for a Aetna Healthy Rewards Lite member.
What is a:
• Healthy Home Visit
• Preventative Screening (Breast Cancer Screening OR Colon Cancer Screening OR Depression Screening)
• Diabetes Series (A1C, Diabetic Eye Exam, and Following doctor's care plan if they have a formal diabetes DX)
• Annual Wellness Visit (OR Annual Physical)
• All Vaccines (Flu OR COVID OR Hep-B OR Pneumococcal)
This part of Medicare covers prescription medications.
What is Medicare Part D?
This is used to view letters and documents (such as reimbursement) sent to us by members and providers.
What is ECHS?
This is where you would navigate to find if the Member is registered online via GPS.
What is Member Name -> Scroll to Member Details -> Find via Online Self-Service Registration?
The system we use that houses HIPAA information.
What is GPS?
This is the name of the new payment choice for 2025 Medicare Prescription Plans that will cause you to transfer to Part D for more information.
What is the Medicare Prescription Payment Plan (M3P)?
Going without credible coverage for 63 days or more could result in this.
What is a Late Enrollment Penalty?
This is a NextGen system that we use for member enrollment submissions, disenrollment submissions, member changes, and enrollment monitoring from start to finish.
What is Market Prominence?