QUEST
Being able to put yourself in "someone else's shoes" is what QUEST principle?
What is Empathy?
What is our exclusive brand for Diabetic supplies?
What is OneTouch/Lifescan?
This is an annual timeframe that allows members to change their insurance plans or enroll into a new plan.
What is AEP (annual enrollment period)?
What system do we house precertification's in?
What is Medcompass
How many levels of appeals are there?
What is 5
This is what each acronym in QUEST stands for.
What is Quality, Understanding, Empathy, Sensitivity, and Trust?
What would be the steps in GPS to send out a provider directory?
Click on add SR, scroll down to provider directory, click next and follow the workflow
When you are lost and not sure where to go or what to do what resource should you use first?
What is Knowledge Articles
What system do we use to process premium payments?
What is PNC
What is the turnaround time for a standard authorization pre-service for Aetna to make a decision?
What is 14 calendar days
Building rapport is also building this.
What is Trust?
Who is the vision provider for FL only?
What is Icare Health Solutions
This commonly used website allows members to shop for Medicare plans, view their star rating and evaluate costs.
What is Aetna.com/Medicare
What system do we house appeals & grievances?
What is Medhok
CSR's handle expedited appeals orally over the phone TRUE or FALSE?
What is TRUE
Where do we go in GPS to see the mbr's Medicare number?
What is the Medicare Attributes
What benefit would a hospital bed fall under?
What is DME
What 3 systems could we use to verify if a provider is participating with the member's plan or not?
What is SFE, RUMBA, HRP
What is our main enrollment system?
What is Market Prominence
What is the turnaround time for a standard appeal pre-service for Aetna to make a decision?
What is 30 calendar days
What is LIS? & Who could assist the mbr?
Low Income Subsidy (also referred to as Extra Help)
Benelynk (Every State except FL)
FL (Government Programs Unit)
Where in GPS can you see if a mbr has used a benefit and how much they having remaining on a benefit
Accumulators
What resource can we use to view detailed information about the mbr's benefits?
What is the EOC
What 3 systems can we use to find the provider's role with Aetna?
What is SFE, RUMBA (EPDB), HRP
If a mbr is calling in regards to a MRI, CT Scan or PET scan authorization denial where would you look to give them the reason why the authorization was denied?
What is Evicore/Carecore