Resources
A member calls in regarding a Prior Authorization being denied, you see the denial in Medcompass but cannot locate a denial letter. What is your next step?
A member calls to check in, about a reimbursement form they sent in. What tool do you use to check we received it, and what is the TAT (Turn around Time)?
IOP Document Viewer
https://internal.aetna.com/DocumentViewer/home
ECHS
https://www20.aetna.com/ECHS/EchsHome.html
KA 2778 - Member Reimbursements
https://service360.lightning.force.com/lightning/r/Knowledge__kav/ka7fp0000005qcHAAQ/view
It may take up to 45 days to process the claim and an additional 7-14 days to receive payment.
What is the Pharmacy coverage for Mitsubishi Motors North America, Inc. ?
A member is questioning a LEP (late enrollment penalty) charge. Where do you go to find more info on why this was applied ?
A member calls in asking about coverage for atorvastatin. Where would would we find out if the drug is covered, and whether it is part B or Part D ?
Formulary and drug look up tool
https://www20.aetna.com/RxDrug/lookup/drugLookup.do
KA 4523 - 2026 Formulary – Medicare Prescription https://service360.lightning.force.com/lightning/r/Knowledge__kav/ka7fp0000005o4DAAQ/view
Who is Pinellas County (Board of County Commissioners) PSL ?
Chrystal Rodriguez (Primary)
Lakieshah Webb (backup)
PSPP
https://datahub.aetna.com/pst/en/pspp/medicare/pinellas-county.html
PSPP Share Point
https://aetnao365.sharepoint.com/sites/MSOGroup/SitePages/Group%20PSPP%20(New%20PST).aspx
A member calls in about constantly receiving a bill, upon checking the EOB, we determine the member is not responsible for payment. What do we do if a compliance letter has been sent already and it is past the 60 days ?
KA 4217 - Balanced Billing
Send SR to the task team to have the issue escalated via the NAF form same as you would send a claim to task.
https://service360.lightning.force.com/lightning/r/Knowledge__kav/ka7fp0000005rDNAAY/view
What tool do we use to view paper enrollment applications ?
CWAS (Coventry Prod)
https://coventry-cwas.portal.conduent.com/coventry/login.aspx
Who handles billing for Kansas State Employee Health Plan ?
PSPP
PSPP PSPP Share Point
https://aetnao365.sharepoint.com/sites/MSOGroup/SitePages/Group%20PSPP%20(New%20PST).aspx