Maria Garcia, an Aetna member.
Calls in at 3:00 PM EST and immediately
says Spanish. What should you do?
>dial the language line at 1-866-874-3972.
____ is the practice of ensuring insurance claims are not paid multiple times
when an enrollee is covered by several health plans at the same time.
> COB
How do you identify prepackaged medication when running a test claim in
Compass?
> when running a test claim encompass a warning. Icon displays a message.
The quantity entered is not a multiple of the package size.Test claim run with
this quantity may not provide accurate pricing as the pharmacy may need to
dispense. A different quantity
which statement best describes a quality of care grievance.
> expression of dissatisfaction with the Part D plan standard of health care.
This includes whether health care services have not been provided or have
been provided inappropriately inappropriate settings.
Which of the following vaccines? Is covered under Medicare Part D?
> Shingles Vaccines - Herpes Zoster
can you file a grievance if a member calls to report three months after the
event triggering their complaint occurs?
> No, this is outside of the window to file a grievance or letter.
A beneficiary calls and states they would like to apply for the low income
subsidy, or LIS. What should you do?
> Contact benelynk for assistance for applying
You take a call from a member. You notice that view opportunities is flashing
in people safe or compass rather. And you offer him the other refill program,
health engagement engine, or HE opportunity. The member said he'd like to
go ahead and enroll his prescription into this program and you enroll him
accordingly. How would you disposition this HE opportunity?
> positive response with action taken.
Members should receive the ID cards in ___business days
>7-10
What is Not a benefit of the member engagement program.
> Get the most current status and or updates regarding your mail order
prescriptions without having to call us
John Wick is requesting to be reimbursed for using an out of network
pharmacy when he was on vacation He was told that he needs to submit a
completed prescription drug claim form and a detailed pharmacy
prescription receipt. What is the general address that he can submit his
paper?
> Aetna Integrated Pharmacy Solutions P.O. Box 52446 Phoenix, AZ 85072-
2446
Mr. Thompson is needing to request an appeal and only has three days of the
non covered medication on hand.What type of a fill should be? What type of
appeal should be requested
> expedited
All of the following are example of grievance exempt.
> This pleasure with what the beneficiary is supposed to pay.
Mrs. Ewin receive a letter stating that her request for a coverage
determination was denied. She calls in to see what else can be done because
she cannot or she cannot take any Therapeutic alternatives.What option
could you offer to Mrs Erin
> File an appeal on her behalf.
What action must you take after entering an override en compass?
> run a test claim to verify that the override is working as intended.
member has just pick up her lisinopril. When her purse was stolen with her
medication inside. She calls in to see how she can obtain a replacement
supply. How would you assist her?
> check to see if lost, stolen, damaged meds override is allowed.
Where must you look in compass to see if a vacation override is on file?
> override BA history hyperlink within the Quick Action's panel on the claims
landing page.
What phone number will be provided to a prescriber if a nonspecialty
medications require a prior authorization
> 1-877-827-7315
Which of the following expressions display the satisfaction from the
beneficiary? Select the three answers that apply
> this makes me upset , This is frustrating. I've called five times for this very
same issue.
Mr. Kosh called because he had submitted a paper claim for multiple
medications that he picked up at an out of network pharmacy while he was
on a trip out of town. The reimbursement he receive was substantially less
than he was expecting. How would you explain the difference in the refunded
amount
> Apologize to Mr. Cash and explain that the reimbursement is based on the
insurances or the insurance negotiated rate with the pharmacy, which is
likely lower than what he paid out of pocket at an out of network retail
pharmacy.
Mrs Jameson call Because she cannot open her prescription bottles.How
would you assist her?
>Request non childproof cabs for Mrs. Jameson via support task
Member calls in to request a print out of her yearly prescription cost. She
tells you she does not have a computer, so you decide to request that. A
statement of cost or SoC be mailed to her. After you have placed the order
for her SoC, Mrs. Williams ask you to also send one of her for husband or one
for her husband. To a different address than. What do we have on file for
him? You have confirmed that she does not have a legal documentation like
the power of attorney to represent her husband. What is the correct action
for you to take at this point
> Inform Missus Williams that Mister Williams will need to make this request
in writing to the Aetna legal Department.
Which platform? Thus, a member use to obtain and submit a request for a
new ID card.
> aetnamedicare.com.
