Claims
Standard claim processing turnaround time is how many days ?
7- 10 business days
This system sends out emails and text messages to members.
Agent Tool
This person answers your questions when you type in her search bar.
Carmen
This service allows members to access certain services and specialist without a referral
Direct Access
Who is the CEO of CVS?-
Karen Lynch
What is the coverage code for a in network provider?
03
This system stops pay on checks/re-issues
MIRI
This link provides access to the automatic Adjudication Online Reference.
AAOLR
True of False Aetna Standardly covers all foot orthotics on all plans.
False, Foot orthotics must be written into plan.
Having this on your plan means that even though you're not in your home network, you'll be treated like you were home
Full Reciprocity
What is the modifier for claims telehealth ?
This system checks router list and look at summitted claims from providers.
EWM
Where can all the communications from claims and call policies be found
Communication Center
This is when Physicians charges billed at the time of service throughout the pregnancy
Non-Global
What day are weekly updates due by ?
By end of day Friday
True of False: HMO products on ACAS won't reimburse nonparticipating practitioners authorized as in network or paid as in network who balance bill for the additional charges up to the submitted amount
True
This is used to determine order of benefit determination for COB.
Where can you access E. Policies if you do not already have it saved as a favorite?
NB-ASD toolbar
This program through Evicore is contracted to Aetna for preauthorize specific services.
ECRP
What is the common purpose ?
Advocate for our members best health by helping them get the most from their benefits, building trust and always providing a clear path to care.
List the 4 types of Medicare COB integration methods.
Government Exclusion
100% Allowable
Maintenance of Benefits
Medicare Related Benefits
What system is used to inquire on complaints and appeals status.
CATS
Name all 11 Aetna products
Traditional Choice
PPO
Aetna Select
Manage Choice POS
Open Access Aetna Select
Open Access Manage Choice
Aetna Choice POS II
Open Access Health network Only
Open Access Health Network Option
HMO on ACAS
QPOS on ACAS
What are the 5 W's that should be asked to a member to determine benefit coverage?
Who is performing the service?
What services are they performing?
Where are the services being preformed?
Why are the services being performed ?
When are the services being preformed ?
What year did Aetna join CVS
2017