Knowledge article
Where can you find the Find Care Disclaimer?
KA 3097
Where would you see the 2025 plan offerings for City of San Antonio?
Tool kit> bottom of the page> plan offerings
Where in the KB's is the definition of voluntary vs involuntary disenrollment?
Knowledge Bases> Glossary > Voluntary vs. Involuntary Termination
Where would you find a precertification is present?
Med compass
Evicore
What is the KA and process for sending out a OTC catalog?
4339 For 2025, Aetna member services will no longer be responsible for processing an OTC catalog request for Aetna Medicare members. All request for a catalog should be re-directed to the OTCHS team. Say: “Thank you for calling today. I am going to transfer you over to the OTCHS representative who will handle your request.”
Then warm transfer the member over to OTCHS at 1-844-428-8147 to complete their order using the one-time exception.
Go to specific group in the toolkit (FEHBP) >billing >
Where in KB's would you find the process for disenrollment for MA Plan?
Knowledge bases> disenrollment/termination > Disenrollment - Medicare Advantage and Stand Alone PDP
Member called to file a ex appeal for a denied AUTH, stars central portal is down, what do you do next?
KA 2825 educates on steps to take if SCP is down.
A member calls in wanting to speak to a supervisor, what KA do you use to follow proper workflow?
4082
Can MHBP members attest to Healthy rewards?
Where would you find this information?
NO
Benefits hot topics> Healthy rewards>
Retirees that have enrolled in the MAPD option can only earn rewards under their MAPD plan.
Where is the MAPD disclosures?
Knowledge Bases>
Medicare Advantage Telephone Enrollment Scripts>MAPD disclosures
How can a member submit a reimbursement claim?
Online, by fax or by mail. KA 2778
What KA do find information on continuous glucose monitors (CGM) ?
KA 4367
PSHBP member is calling in saying her address is still incorrect in the system and its been 45 days. What steps do we take to help the member.
PSHBP > Eligibility hot topic> Address changes>
IF it has been more than 30 days since they called OPM
Surviving spouse calls in stating she needs to make sure she has coverage. Would you send an EET?
YES! VIA KB Surviving spouse that needs to be moved to their own account in the bswift Portal (Retiree is deceased, GPS shows spouse with active coverage but Bswift Portal has no entry under surviving spouse's name, or shows their name , but with no coverage or billing. The Portal under the deceased retiree's name may show only a statement and the statement is for the surviving spouse.)
CVS pre 65 member calling about claims and benefits questions do we handle this call?
NO!
CVS Health (Aetna Inc) > General hot topics > claims and benefit questions>
Also at the bottom of the page >
Traditional Calls
Yes - We handle calls for enrollment, eligibility, & billing for TRAD plans
Please transfer any claims and benefits questions to 800-558-0860
What Knowledge Articles can you use to review the reimbursement process for Group members?
KA 3303 Hearing Aids
KA 2778 Member Reimbursements
KA 4105 Post Cataract Eyewear
Member retiring from McCormick calling in to get information on his Pension Check. How do we assist ?
General hot topics>pension check questions>
If a member has questions about their pension checks, please advise them to call:
Wells Fargo (800)728-3123
Member calls and it seems a Manuel form is needed. where can you find a tip sheet for completing one?
Knowledge bases > Enrollment > Manual form tips and walk through
Where can you find the information needed for Authorized rep form/POA
KA 3701, KA 3989 and KB >enrollment > Authorized Representative and Exceptions