Compliance
T or F: We can call the mm on the backline to get auth to speak with daughter to report for the HYR gift card?
What is False: Ka 3704
In 2026, New and Existing members have the option to attest for SSBCI by what method?
What is Provider attestation form: KA 4491
T or F: Aetna Covers Lasik Surgery for cataract removal 101346479000
What is False: KA-4370 Services not covered by Medicare/Routine eye examinations, eyeglasses, radial keratotomy, LASIK surgery, and other low vision aids
T or F: If caller doesn't have their Aetna ID or MBI, we can not assist.
What is False: Ka 2605
What Pieces of information should we verify when a member comes in full on CTI pop?
What is Say: “Hi, my name is ________, May I ask whom I am speaking with? I see that you have been authenticated through the system. Thank you. Is this the first time you have called us about this issue?"
Note: If not speaking with the member: Say: “May I please have your relationship to the member and member name?”
Ka 2620
T or F: Due to the fact we send monthly invoices, we can only submit payments for that monthly amount?
What is False: KA 2824
How many chronic conditions qualify for SSBCI?
What is 26:Ka 4491
T or F: if a member wishes their family member to get paid for ADL per the guidelines we would reach out to the CM to get the care giver signed up to provider services?
What is False: Custodial care Custodial care is personal care that does not require the continuing attention of trained medical or paramedical personnel, such as care that helps you with activities of daily living
T or F: When mm is scheduling NEMT, The correct process is to warm transfer to NEMT vendor?
What is False: KA 4363
Offer to set up or cancel the appointment based on the call.
Say: "Would you like me to set up (cancel) an appointment for you, today?"
What is Scrooge's first name?
Who is Ebenezer
T or F: It is necessary to confirm the phone number on the account 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
What is the criteria for an indiv member to qualify for SSBCI?
What is Non-DSNP members must meet both of the following to qualify for SSBCI and receive this wallet:
KA 4466
T or F: If a member has a provider submit authorization for a stair lift in their home and one for their car due to being in a wheelchair Aetna will cover it?
What is False: KA-4365
T or F: If a mm is calling in initially expressing dissatisfaction about their LEP, we would tell the mm we are going to a file a grievance on their behalf?
What is False- Ka 3109
In 2026 if member does not have an Extra Benefits card how will they collect rewards?
What is If a member does not have an Extra Benefits Card, and they attest to a Healthy Rewards activity, we send the card in 10–14 days
KA 4509
What pieces of information must we request to authenticate when a call has dropped and we call the mm back?
What is zip code and DOB: KA 2588
Where can we find the qualified chronic conditions?
What is EOC: Ka 4491
How Many Days are Medicare Advantage Members limited to for Physical therapy in a calendar year?
What is none: KA 3103
T or F: If the mm wants to change their plan per the work flow, we transfer to Tele sales?
What is False: Ka 2806
Check to see if there is currently an agent-of-record on file. Go to the Knowledge Article: Medicare Member - Customer Service Broker Lookup Tool
If the member has an agent of record assigned to them.
Note: If the member asks for the broker or agent phone number, we can share that information if it is listed.
Name all of the 7 dwarfs (Snow white)
Who are Sneezy, Happy, Sleepy, Doc, Grumpy, Dopey, Bashful
T or F: We must obtain verbal authorization to speak with a non member to review the member's benefits?
What is False: KA 3704
What is the form number for the provider attestation form?
What is Form Number - GR-69740 found KA 4491
Using this Member ID 101346479000 what is this members cost share for ground ambulance?
What is $275 copay for each Medicare‑covered one‑way trip via ground ambulance.
T or F: if mm's application is place in RFI status for missing information, we would transfer to enrollment.
What is False: KA 4428
****DAILY DOUBLE****Name all of Santa's (9) Reindeer
Who are: Dasher, Dancer, Prancer, Vixen, Comet, Cupid, Donner, Blitzen, Rudolph