Resources
How do you create the SR for ID card when one has not been requested to be sent?
Click on the image of the ID card and an SR will be created automatically.
What is one of the reasons that the member would lose the extra benefits?
1. Loss of LIS/Extra Help
2. Plan Change
3. Loss of Coverage
Name 2 ways in which the member can request their Medicare ID card.
1. They can call 1-800-MEDICARE (1-800-633-4227 TTY 1-877-486-2048)
2. They can request a replacement online at Medicare.gov.
KA 4253
True or False
Benelynk is an Internal Vendor.
False.
Benelynk is an independent company that works with various health plan including Aetna to help members access benefits and resources.
KA 3665
True or False
For every Aetna plan, members have 60 days to file a grievance.
False
Florida(FL) DSNP is the exception, they have 365 days from the date of the incident to file the complaint.
KA 3109
Which application do we use to confirm the Agent of Record for an account?
Market Prominence or MP
What is the correct TAT for ID card when the Quickbase is used to assign the PCP due to GPS error?
2 - 3 weeks. And if there is an issue, they will receive a call.
KA 3210
Name 2 items that are no longer included in the member kit and must now be sent separately.
1. Formulary
2. ANOC
3. EOC
4. Journey Handbook
5. Provider Directory
KA 2800
Give 2 reasons to request the address on file?
1. Verification
2. Sending material
3. Address error notification (OOA)
What is the TAT (turn around time) for a standard Pre-Service appeal?
What is 30 calendar days- KA 3110
When an individual mm is calling to change Case Manager what KA would we use?
What is KA 2710?
T or F: If Liberty Dental is the dental vendor and the mm wants to file an appeal, we would then transfer the call to Liberty Dental.
What is False KA 4326
***Medicare CSR Member Dental Complaints and Appeals
True or False
After the second visit to Oak Street PCP, there will be no changes.
False
Oak Street Health will make a change after the 2nd appointment (Wellness Review) and a new ID card will be sent after the change.
KA 4278
Name 3 pieces of verification information that we can volunteer to the member?
We are not allowed to provide information to the members. The information is to confirm once the member provides it.
T or F: If a mm no longer has coverage with Aetna, we are only required to provide them with the phone number to the other carrier?
What is False- we should be offering the phone number as well as offering to connect them over to the new insurance carrier.
Also, we address any questions they have re the plan they had with us.
Which KA covers the process for releasing information on Outbound calls?
KA 2677(How to Release Information Outbound Call)
2588(Disconnected Caller)
T or F: Can a Indiv (Non-GROUP) mm with a PPO plan use ONN coverage for hearing aids?
What is False KA 4317
Under what circumstances can a broker cancel a plan?
The broker listed on the application may also request to cancel the plan without needing to read the POA attestation. Note: The broker that is requesting the cancel must match the broker on the application to cancel.
KA 3518
Details regarding EOB's are considered Level 1 or Level 2 information?
What is Level 2- KA 3704
What are the cases that require revalidation?
1. External transfer.
2. CTI shows not verified/partial validation
3. Corporate calls.
4. Transferring agent advised plan not validated.
KA 2620
T or F: To invoke the urgent eligibility process with EyeMed, we would follow the process outlined in KA 4204 and reach out to mentor to fill out the Medicare Product Implementation escalation QB?
What is False KA 4369
When changing a Provider with the PCP QuickBase, What PBG types are acceptable?
What is PMDF and PMDC- KA 3210
What specific information must we request prior to the changing of a member's address?
What is MBI number (current) KA 3272
T or F: If it is necessary for the treatment of a mbr we can release the MBI to a provider If the provider has a NPI/Tax Id and are inn with Aetna?
What is False- 2620/3666