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
T or F: If a new member wants to attest for SSBCI, we should send the provider attestation form?
What is False Ka 4491
T or F: Aetna Covers Lasik Surgery for cataract removal 101206124300
What is False: KA-4370
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 with Helper Bees.
What is False: KA 4328
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 was the name of Charlie Brown's Dog?
Who is Snoopy
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
T or F: If the mm qualifies for SSBCI, their OTC balance doubles?
What is False: KA 4466
DSNP Plans will start as an OTC Wallet and upgrade to an Extra Support Wallet if they qualify for SSBCI
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
Members may continue with treatments if providers feel it is medically necessary.
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
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 101789129400 what is this members cost share for ground ambulance?
What is $295 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