Foundations
Call Components
Eligibility
Policies
GBC
100
is a web-based application, that Aetna uses to house all claim and call policy and procedural information. This houses Aetna guidelines when a plan sponsor doesn’t cover an item or service
E.Policies
100
is the first line of service to our providers when they call in.
Aetna Voice Advantage (AVA)
100
The primary source of all provider information.
Provider demographic information, basic contract information and network participation components
EPDB
100
is an add-on feature that a plan sponsor can add on to one of the following managed plans
Open Access
100
a cost-sharing arrangement in which the Aetna member pays a specified flat amount for a specific service
Copay
200
Describes providers who are contracted directly with Aetna on all of our standard products.
Direct Network/Broad Network
200
is not only hearing the words but also understanding the message your customer is trying to convey.
Active Listening
200
The time period, for which the insured can choose new/different insurance, add/remove dependents or make changes to a plan.
Open Enrollment
200
is a standard plan feature for plans that require a referral. This feature allows members access to certain medical services and specialists without a referral
Direct Access
200
predefined dollar amount that must be paid by the member toward the cost of covered services before the plan begins to pay benefits
Deductible
300
A network created when a product is built around a more specific or limited pool of providers.
Passive Network
300
The four different types of questions you may need to use to identifying the issue
- Open-ended questions
- Closed-ended questions
- Probing questions
- Clarifying questions
300
Do we cover newborn?
Coverage for newborns is automatic. We must provide coverage for newborns from the moment of birth through the 31st day of life even if the intent of the employee is not to add the newborn to the policy.
300
This product offers the member the greatest freedom of choice, These plans don’t use networks
Traditional Choice (Indemnity)
300
dollar maximum a member must pay before the plan will pay at 100%
Coinsurance Limit / OOP Maximum
400
responsible for creating and maintaining business relationships among providers (except mental health and dental) in the various territories.
Network Management
400
Once a CTI Pop appears what button are you to press to select the exact provider who will be rendering the services
Provider Search Results button.
400
What are the two Common Purpose tools
- Lifelines
- Catalyst Initiatives
400
Name all the plans that has an Open Access built into it
Open Access Aetna Health Network Only
Open Access Aetna Health Network Option
400
The ____ is usually two or three times the individual limit, which will be defined by the plan.
Family Limit
500
Our Common Purpose
Advocate for our members best health by helping them get the most from their benefits, building trust and always providing a clear path to care.
500
if no COB found in the patient's account how do we document the information?
tick the box on the upper right hand corner in ASD.
500
There are 2 ways to navigate to NV screen, indicate how to navigate from Provider Summary screen.
from the Provider Summary Information screen
Type an X in the SEL field next to the network ID + enter
Type NV in the TPGN field + Enter.
500
Name all the policies that can be offered of an Open Access
Managed Choice
Aetna Select
Elect Choice
500
is a specific dollar amount that can be paid on covered services during an individual's lifetime.
Lifetime Maximum