Aetna Medicare

Claim/Benefit

100

Service done on 12/05/21

What is Date of Service(DOS)?

Enrollment/Disenrollment

200

Open Enrollment Period

What is 01/01/9999 - 03/31/9999

500

Ways to disenroll

What is:

Submitting a letter stating reason member wish to disenroll

Call Medicare

Enroll in another MA Plan

True/False

100

Annual  Enrollment Period (AEP) runs from 09/01/9999- 11/30/9999

False

From October 15 to December 7 each year 

200

Reimbursement Claim can be submitted 2 years after DOS

False

What is, claims can only be submitted within one year after the DOS?

400

All Medicare Advantage members are eligible for Preventative Care Services free of cost

True

500

Members on SSA premium withhold (SSPWH) are exempt from plan termination for lack of premium payment

TRUE

What is:

• This exception applies once the SSPWH option becomes effective.
• For any premiums due, before the SSPWH effective date, Medicare Advantage and Rx Premier PDP members aren’t subject to disenrollment if they fail to pay the direct-billed premiums.

System Usage

100

Updating a member's address

What is RUMBA?

200

Checking the status of a Precertification/Preauthorization

What is Evicore/Medcompass?

300

Quoting a member's benefit

What is ASD/MAP Tool?

400

Paying a member's premium

What is PNC Biller/IVR System?

500

Checking if a provider is INN

What is a DocFind?

Where would I Find?

100

I want to check the status of an appeal/grievance

What is MedHok?

200

I need an OTC Catalog

What is OneKit?

300

I need a coupon book mailed out

What is ASD/Transdirect?

400

I need a new id card, but I'm at another address

What is Member Pull Request?

500

I just mailed out my reimbursement claim

What is ECHS?