Random
Which of the following CPT codes requires precertification in network? (3 points)
a. 77200
b. 99214
c. 23472
d. 36415
C.23472
The member calls asking if they have any coverage for gym memberships. After reviewing their plan in ASD and the Plan Sponsor Profile Page, you note there is no coverage. What could you offer to the member that would help them save on gym memberships?
FITNESS DISCOUNT PROGRAM or GLOBALFIT
The maximum number of names that can appear on a family ID card is:
a. Four
b. Five
c. Six
d. There is no limit. We will print the subscriber and ALL eligible dependents on the same card.
B. Five
A member has a plan with a $500 deductible and 10% coinsurance. They’ve met $300 of their deductible to date. For a service contracted at $600, what would the total member responsibility be?
$240
Plans Sponsor eligibility information, such as the definition of dependents, probationary periods and Coordination of Benefit types can be found in ASD in all the following places EXCEPT?
a. Benefit Detail
b. General Policy Provisions
c. Account Remarks
d. Plan Remarks
A. Benefit detail
The member calls and provides procedure code 28293 and diagnosis code M20.23. They would like to know if the services will be allowed or denied. What would you advise?
Denied
This can be sent to members/providers to help them determine Aetna’s policy regarding the experimental and investigational status and medical necessity of medical technologies that may be eligible for coverage under Aetna medical plans. As a Health Advocate or Health Concierge, we are not allowed to interpret these policies.
CLINICAL POLICY BULLETIN (CPB)
Using member ID W04651012401, Freson Memberone, *TEST* QUALCOMM, which of the following individuals could not be covered under the plan? (3 points)
a. The Subscriber’s spouse
b. A 23 year old child
c. An Incapacitated child
d. Sontwo’s daughter that lives with her Mother
D. Sontwo’s daughter that lives with her Mother
A member has an HMO on ACAS plan and has an MRI and a chest X-ray done at the same facility on the same date of service. The MRI copayment is $50 and the X-ray copayment is $25. What will the total member copay be for this date of service?
$50
Aetna standard guidelines state that routine pap smears are covered for women beginning at what age?
21
Utilizing the Plan Sponsor Profile Page, what is the Plan Sponsor name for Control 143782?
Accuweather
What is the system limit for ordering ID Cards? (3 points)
a. Two a day.
b. Once every 7 days.
c. There is no system limit. You can order as many as are requested.
d. Once every 24 hours.
D. Once every 24 hrs
Using ASD outbound emails, how many emails can be sent per request? (3 points)
a. One per request
b. Up to two per request
c. As many as are requested
d. Up to three emails per request
D. Up to three emails per request
What type of mammogram is performed to diagnose a specific medical condition?
MEDICAL OR DIAGNOSTIC
Members that are unable to wait 24 hours to receive requested email via the AGENT Tool can request to have their email sent as urgent. The CSR will send a request to what email address? An auditor will typically handle these urgent requests within 1-2 hours of receipt.
AETNAMEMBERSERVICEQUALITYMAILBOX@AETNA.COM
Using the Precert Code Lookup Tool, for CPT code 19340, which of the below CPBs should be provided as a reference to the member? (3 points)
a. CPB 290
b. CPB 71
c. CPB 17
d. CPB 440
C.CPB 17
For Traditional plans that have Routine Benefits we standardly cover colonoscopies for members age 45 and older once every ____________ years
10
This is a web-based application that will generate emails or text messages to members that are interested in receiving additional information regarding their benefits.
AGENT TOOL
All the following are types of address changes EXCEPT: (3 points)
a. Confidential communications address change
b. Permanent address change
c. Temporary alternate address change
d. Member requests to have no address listed on file
D. Member requests to have no address on file.
This is a type of code that is billed by a provider that tells us why a member had a procedure, office visit or service provided.
Diagnosis Code
Which tool would you access to review written correspondence to and from our members and providers? (3 points)
a. COB
b. ECHS
c. Agent Tool
d. OBC
B. ECHS
This is the time of year that the Plan Sponsor allows their eligible employees to add or make changes to their benefits. These changes become effective on the Plan Sponsor’s renewal date
Open Enrollment
Standard letter requests, such as Verification of Eligibility, may be generated using what tool? (5 points)
OBC
Are you ready for your assessment?
YES!!!
All the below are considered examples of qualifying events EXCEPT: (3 points)
a) Moving into a service area
b) Not happy with their current plan
c) Termination of employment
d) Divorce or legal separation
B. Not happy with their current plan