Compliance 1
T or F: Because CM's are internal Aetna employees (have Aetna ID) they can attest for gift card without the mm being present?
What is False KA 4391/3641
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
What is the TAT (turn around time) for a standard Pre-Service appeal?
What is 14 days- KA 3109
T or F: If a mm has exhausted their trip benefit, we can reach out to the CM on file to facilitate the additional trips?
What is False Ka 3750- Cm's can only assist with exhausted trips for Chemo, Radiation, Dialysis
T or F: In order to ensure the mbrs have the most seamless experience possible we would reach out to the provider and give them the mbr’s Medicaid number after we have determined the claim did not process correctly due to no Medicaid number being on file?
What is False- KA 2677
T or F: We must request the MBI in order to update payment method for Auto Payment via PNC?
What is False KA 2708
T or F: If a FL (Florida) mm is having an issue with their eyewear claim, we would then transfer them over to ICARE since ICARE is the delegated eyecare vendor for FL?
What is False KA 4333
T or F: If a mm states that they are upset with Medicaid for not providing them with more hours for custodial care, we would tell the mm we are going to a file a grievance on their behalf?
What is False- Ka 3109
Do we handle CSNP plans?
What is NO we do not they have a dedicated team CS in KA 2621
T or F: If a call comes in partially validated, we only ask for the information not checked in the CTI pop?
What is False- Ka 2620 Say: “Hi, my name is _______. It looks like your validation didn’t fully come through. Can I please have the member’s name, date of birth and ID number? May I ask with whom I am speaking. Is this the first time you have called us about this issue?”
T or F: It is necessary to confirm the phone number with the member on every call?
What is False- KA 4254 If phone numbers on the CTI pop match phone numbers on the member’s file, no need to verify
T or F: Can a Indiv (Non-GROUP) mm with a PPO plan use ONN coverage for hearing aids?
What is False KA 4317
All Aetna Medicare Members have 60 days from the date of the incident to file a STANDARD grievance?
What is False FL is the exception - KA 3109
What was Usher doing at 7'oclock?
In his drop top CRUSSSSINNNNN the streets!!
T or F: If a mbr has lost their MBI Card (red/white/blue card) we would advise them to reach out to Social Security at 800-772-1213
What is False direct them to MEDICARE 1-800-633-4227 - KA 3666
What pieces of information must we request to authenticate when a call has dropped and we call the mm back?
What is zipcode and DOB- KA 2588
What is the VDN for non-Liberty DSNP dental plans?
What is 26163- found in KA 4355/3146
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.
When changing a Provider with the PCP QuickBase, What PBG types are acceptable?
What is PMDF and PMDC- KA 3210
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
Details regarding EOB's are considered Level 1 or Level 2 information?
What is Level 2- Ka 3704
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
T or F: As CSR we only assist member's with filing pre-service expedited appeals?
What is FALSE, Florida DSNP plans are the exception to the rule with how we can accept appeal requests. Medicare CSRs will be able to take verbal appeal requests from Florida DSNP members. The appeal request can be taken verbally for both expedited and standard issues. Ka 3110
When a individual mm is calling to change CM what ka would we use?
What is KA 2710
What specific information must we request prior to the changing of a member's address?
What is MBI number (current) Ka 3272