Outbound
Members that are unable to wait 24 hours to receive requested email via the AGENT Tool can request to have their email sent as urgent. The CSR will send a request to what email address? An auditor will typically handle these urgent requests within 1-2 hours of receipt.
AETNAMEMBERSERVICEQUALITYMAILBOX@AETNA.COM
The maximum number of names that can appear on a family ID card is:
a. Four
b. Five
c. Six
d. There is no limit. We will print the subscriber and ALL eligible dependents on the same card.
b. Five
A member has a plan with a $500 deductible and 10% coinsurance. They’ve met $300 of their deductible to date. For a service contracted at $600, what would the total member responsibility be?
$240
This is a type of code that is billed by a provider that tells us why a member had a procedure, office visit or service provided.
DIAGNOSIS CODE
This can be sent to members/providers to help them determine Aetna’s policy regarding the experimental and investigational status and medical necessity of medical technologies that may be eligible for coverage
CLINICAL POLICY BULLETIN
Plans Sponsor eligibility information, such as the definition of dependents, probationary periods and Coordination of Benefit types can be found in GPS in all the following places EXCEPT:
a. Helpful Resources
b. Additional Benefit Coverage
c. Control Remarks
d. Plan Remarks
a. Helpful Resources
Aetna standard guidelines state that routine pap smears are covered for women beginning at what age? (5 points)
21
A member has an HMO on ACAS plan and has an MRI and a chest X-ray done at the same facility on the same date of service. The MRI copayment is $50 and the X-ray copayment is $25. What will the total member copay be for this date of service?
$50
The member calls asking if they have any coverage for gym memberships. After reviewing their plan in GPS and the Plan Sponsor Profile Page, you note there is no coverage. What could you offer to the member that would help them save on gym memberships??
FITNESS DISCOUNT PROGRAM or GLOBALFIT
This is a web-based application that will generate emails or text messages to members that are interested in receiving additional information regarding their benefits
AGENT TOOL
Which of the following statements are true regarding an ID Card Pull Request: (3 points)
a. You should submit the ID Card Pull Request form before ordering the ID card in GPS
b. You should order the ID card in GPS and wait 24 hours before submitting the ID Card Pull Request
c. Only requests for family ID cards can be submitted through the ID Card Pull Request
d. You can use the ID Card Pull Request form to request expedited shipping of an ID card with your manager's approval
a. You should submit the ID Card Pull Request form before ordering the ID card in GPS
b. You should order the ID card in GPS and wait 24 hours before submitting the ID Card Pull Request
c. Only requests for family ID cards can be submitted through the ID Card Pull Request
d. You can use the ID Card Pull Request form to request expedited shipping of an ID card with your manager's approval
For Traditional plans that have Routine Benefits we standardly cover colonoscopies for members age 45 and older once every ____________ years.
10
Using the screenshot, answer the following question: How much is remaining to meet the family deductible for the calendar year?
$4893.41
Which of the following CPT codes requires precertification in network? (3 points)
a. 77200
b. 99214
c. 23472
d. 36415
c. 23472
Using the Precert Code Lookup Tool, for CPT code 19340, which of the below CPBs should be provided as a reference to the member? (3 points)
a. CPB 290
b. CPB 71
c. CPB 17
d. CPB 440
c. CPB 17
What is the system limit for ordering ID Cards? (3 points)
a. Two a day.
b. Once every 7 days.
c. There is no system limit. You can order as many as are requested.
d. Once every 24 hours.
d. Once every 24 hours.
This is the time of year that the Plan Sponsor allows their eligible employees to add or make changes to their benefits. These changes become effective on the Plan Sponsor’s renewal date
OPEN ENROLLMENT
23. All the following are types of address changes EXCEPT: (3 points)
a. Confidential communications address change
b. Permanent address change
c. Temporary alternate address change
d. Member requests to have no address listed on file
d. Member requests to have no address listed on file
All the below are considered examples of qualifying events EXCEPT: (3 points)
a) Moving into a service area
b) Not happy with their current plan
c) Termination of employment
d) Divorce or legal separation
b) Not happy with their current plan
Which tool would you access to review written correspondence to and from our members and providers? (3 points)
a. COB
b. ECHS
c. Agent Tool
d. OBC
b. ECHS
When using the Agent Tool to send outbound emails, how many documents can be attached per email? (3 points)
a. One per request
b. Up to two per request
c. As many as are requested
d. Up to three emails per request
a. One per request
What type of mammogram is performed to diagnose a specific medical condition?
MEDICAL OR DIAGNOSTIC
Pick a number between 1-100
77
Utilizing the Plan Sponsor Tool, what is the Plan Sponsor name for Control 143782?
ACCUWEATHER
Standard letter requests, such as Verification of Eligibility, may be generated using what tool?
OBC