Name that QUEST statement!
I can understand how frustrated this must make you feel.
EMPATHY
What is the name of the resource in GPS that you can use to review processes and workflows?
Knowledge Articles
When a member expresses dissatisfaction about any aspect of the operations, activities, or behavior of a Medicare health plan, or its providers, what should be filed?
Grievance
Which two systems allow you to see claims information?
GPS and HRP
MEDHOK
So just to recap, I advised you about your office visit copay today.
SUMMARIZE
What is the name of the website where you can view policies for Medicare HRP topics?
ePolicies
A grievance must be filed within how many days of the incident?
60 days
The amount that Aetna pays to the provider is called the __________ .
HCC amount or Paid amount
Which system does the claims department use to process and pay claims?
HRP
Just to make sure that I understand your concerns, you are calling to find out the copay for an MRI, is that correct?
PARAPHRASE
What team can you call if you need help understanding a policy or workflow?
Mentor line or team
What should you NEVER ask a member when it comes to grievances?
If they want to file a grievance
What are the three cost share types?
Deductible, copays and coinsurance
What is the main system that you will log into every day at the beginning of the day?
GPS
Thank you for calling! My name is ______ . Am I speaking to the member?
GREETING
What team receives tasks that are submitted in GPS when a member needs to be contacted for follow up on an issue?
Task team
Which system do you use to file a grievance?
GPS
What is the name of the section in HRP or GPS that allows you to see the CPT codes and descriptions billed on a claim?
Claim lines or lines
Which system allows you to see the status of an authorization and case manager info?
Medcompass
APPRECIATION
What team can you call if a member continues to call in with issues accessing their care (i.e. cannot get an appointment with a doctor, unable to get a referral to see a specialist, in-network doctors saying they do not accept Aetna).
Access To Care
What service request reason should you choose when filing a grievance in GPS?
Complaint/ Appeal/ Authorization
What can a member file if a claim is denied?
Appeal
This is one of the next generation systems that we use for member enrollment submissions, disenrollment submissions, member changes and enrollment monitoring from start to finish.
What is MarketProminence (MP.aetna.com)?