Benefits & Costs
This is the amount a member pays for a covered service, usually at the time care is received.
What is a copay?
In STARS, this button is used to get cases.
What is Tasks?
The Post Call Assessment is required when the call outcome is this
What is Activity Completed?
At the beginning of a member conversation, establish this to set expectations for the call.
What is a call agenda?
This document abbreviation stands for Summary of Benefits.
What is the SOB?
When a plan has both network options, state these two types of copays when applicable.
What are in-network and out-of-network copays?
This system is used to add or change a member's Primary Care Physician.
What is Quickbase?
If you leave a message on the first attempt, use this Call Tracking selection.
What is Not Reached Call → Left Voicemail?
Confirm that the member received this important plan item.
What is the member ID card?
This document abbreviation stands for Evidence of Coverage.
What is the EOC?
Extra Help, also known by this three-letter abbreviation, may affect deductibles, copays, and premiums.
What is LIS?
This system verifies that a member is enrolled in the listed plan.
What is MARX?
Choose this Case Status Reason when a member refuses the campaign and declines follow-up.
What is Declined – Member Declined Call?
During the conversation, confirm the member's primary care provider and these additional providers.
What are specialists?
This Aetna website is one resource for plan questions and referral verification.
What is AetnaMedicare.com?
This four-letter term is the annual limit on a member's out-of-pocket costs.
What is MOOP?
Before dialing, select this number of cases from the member-count drop-down.
What is 10 cases?
After a second unanswered attempt, take this action on the opportunity.
What is close the opportunity?
When reviewing medications, provide this broad scope of drug information rather than only cost, tier, or utilization management.
What is all applicable medication information?
This chart determines Call Status, Call Outcome, Case Status, and Case Status Reason.
What is the If/Then Chart?