Rumba
A system used to update PCP
What is MEM/MEA?
Member needs to submit a claim for prescription reimbursement which form will you send?
What is the Commercial Prescription Drug Claim Form?
What coverage code indicates the claim was processed INN?
What is Coverage Code 03?
This calendar‑based timeframe applies when reviewing and processing documentation for a dependent who qualifies under incapacitated child policy.
What is 30 calendar days?
When sending an email you select what on the main screen?
What is MSM?
Locate which claims were applied to a member's check from Aetna
What is CRS?
Member needs to continue coverage of dependent after age of 26 which form will you send?
What is Request for continuation of Coverage for disabled child form?
Attached DCN or documents are found where.
What is the additional claim information tab?
When an authorization is classified as urgent and requested prior to services being rendered, this is the maximum timeframe allowed for determination under precertification policy.
What is 72 hours?
True or false? You have to download a CPB first before sending an email.
False. You can send CPB directly through agent tool.
Archived claims are stored here.
What is EWMP?
A member who is pregnant and has begun treatment with an obstetrician and gets care from a par provider who: Has a change in plan sponsor specific Home Host network status. What form would you send?
What is the Transition of Care form?
A member calls because their claim was partially denied and they want to know why it was denied.
What is the claim was not denied but adjusted? Billed amount was changed to allowed amount.
After submission, faxed documentation related to Other Services or KTC requests does not appear immediately; according to workflow expectations, visibility in ECHS/EWM occurs within this window.
What is 24 to 48 hours?
True or False? you have to give a disclaimer when sending a SMS.
True. Messaging and data rates may apply.
To Find Reasonable and Customary Rates for OON Providers
What is HMOPROD?
Member needs 3 years of EOB's. Which form would you send?
What is the Authorization PHI Release form?
A member moving between coverage types submits a Transition of Care request. According to policy standards, this is the maximum number of calendar days allotted for processing.
What is 15 calendar days?
True or false? The email address being used has to be on file?
Is the 1095B form is always sent to the member from Aetna.
What is No?
For radiology benefit management requests classified as urgent and submitted prior to services, this is the maximum turnaround time required by EviCore guidelines.
What is 3 hours?
Mbr calls requesting a list of breast pump suppliers.
What is email the National DME list?