Peoplesafe/TheSource
What tab on the Main Screen would you click on to see if the Resolution Manager task was previously created?
Once all the required screens have been reviewed on a test claim, you are permitted to share the results with the caller. What should you always state when giving the caller any copay amounts?( What is it specifically)
What is disclaimer regarding price estimates. “Please note the prices quoted are estimates and may not reflect your actual out of pocket costs.”
Why is it important to check View Activity before creating a RM Task?
What is To avoid duplication of work. Creating a duplicate Task is considered an error and may negatively impact your performance statistics
What tab in PeopleSafe would you click if member is calling about a balance they owe for mail order that was already shipped?
What is
Transaction History tab
If a member calls in stating that their mail order prescription was short three pills, which reship process should you follow?
What is Prescription Quantity Shorted
How can you View EOB's in Peoplesafe?
What is tools Drop down
Mr. Jones wants the Brand Name price estimate for a mediation where the Generic is covered. The CCR must change this, on the Test Claim screen, to what?
What is "May Sub" to Patient – No
What Queue does a CCR use when processing a Payment Dispute RM Task?
What is Queue: Finance - Northbrook
What are the first 4 steps in locating a payment
What is
Authenticate caller
Click Transaction history tab
Click Find payment
Select the appropriate tab for the payment type.
Name the four phases of a Members plan?
What is Deductible, ICL, Coverage Gap and Catastrophic
What Work Instruction will provide you with the address that we provide the member to send in paper claims/
What is
Content ID : CMS-PRD1-067175
Aetna - Researching / Submitting Paper Claims for Direct Member Reimbursement (DMR)
Michael B Jordan Takes 3 tablets per day for a 90 day supply of lisinopril . What is the quantity to be entered in test claim?
What is 270
An RM Task can NOT be edited or cancelled
What is
If a member has a credit balance and requests a refund check, what RM task would a CCR create?
What is
Category: Billing/Payment
Type: Credit on Account/Request for Refund Check
Queue: Finance - Northbrook
What term do we use for the percentage of time that must pass before a plan will allow a prescription to be refilled?
Utilization
What Work Instruction in the source will provide you with the description for a order status in REJECT SCH HOLD ?
What does the order status mean ?
What is
Content ID : CMS-PRD1-087370-Aetna - Order Status Reference Chart
Medicare D Ship Consent Required.
What are the two most critical fields in the Drug Details screen when calculating the quantity for manufacturer packaged medications?
What is Package Size and Usage Qty Pkg
What is the Rm task for a crushed tablet
What is
Task Category: Order Status
Task Type: Damaged Order
Queue: Reships – Participant Services
What is the process for a member calling in stating they did not authorize Aetna to take a payment ?
What is
1. Obtain from the caller:
2. Confirm information with the caller based on the payment type
3. Create a task in RM
4. Advise the caller to allow at least two business days for the transaction to be researched and reversed to their payment account.
When there is an issue with the member’s claim that needs to be resolved (Reject 41), an RM task is created. What Category, Type, and Queue do we use?
What is
• Category: Aetna Internal Process
• Type: Coordination of Benefits
• Queue: ( Aetna Med D – Coordination of Benefits )
What are the types of Diverted orders that can be released by Customer Care making updates on the Manage Diverts screen include
What is
Payment Diverts
Future Fill Diverts
Participant Service Diverts
What is the Quantity for a Humalog kwik pen 75/25, if the member takes 25 units in the morning for a 90 day supply? Use ID: 2653TST01
What is
30
What do you need to do If you need to cancel another user’s RM Task
What is
create a Stop See Comment with the original Task ID number and the reason for cancellation.
What are the different types of payment exceptions ? Name three
What is
Expired Credit Card
Invalid Credit Card Number
Authorization Denied
FSA Credit Card Denied
ECheck Registration Required
High Copay Warning
Maximum Allowable Benefits Exceeded
DAW Cost Difference
Over Order Limit
Over Cardholder’s Limit
Over Cardholders Aged Limit
Partial Authorization
Multiple Electronic Payments
Courtesy Call Med D
Courtesy Call Over Order Limit
Missing Amount
No Card on File / No Method of Payment on File
True or False: With an existing prescription already on file,a CCR may process a refill request for an expired prescription, as long as the physician, day supply and dosage has not changed.
What is True