Communication Methods
What Mentor should you have open daily?
Integrated Calls Document Index
What type of skills are personal attributes that enable advocates to interact effectively and conversationally with callers.
Soft Skills
What is the most common fulfillment request.
Identification (ID) Cards
Where can you view members who already have an assigned PCP on file
Customer Relationship Management (CRM).
What type of caller is a member who has contacted Humana within the last 14 days about the same issue without any resolution.
Repeat Caller
What is used to create or view letters
Enterprise Measurable Messaging Ecosystem or EMME
What type of information is loaded from the member's application.
Pre-populated information
What refers to the materials available to Humana plan members.
Fulfillment
This primary tool is used to assist members to locate participating providers including PCPs
Find Care
What is a Telecommunications Device for the Deaf (TDD) phone
A Telecommunications Device for the Deaf (TDD) phone looks like a small typewriter in which communication is typed rather than spoken. The TDD phone prints a tape (similar to calculator tape) of the conversation.
How long will a verbal consent last?
Only good for one phone call
What should never be given out regardless of if they are authenticated or not.
A member's MyHumana account username
What is used to order paper copies of benefit information such as handbooks and welcome kits.
Order Management System (OMS)
If the doctor is not found or the caller insists a non-par provider is participating, verify the provider's network status using what system?
Provider at a Glance (PAAG) application.
What call type could a member ask to speak directly with a supervisor, another member of Humana management, or a senior executive.
Escalated Call
When is a Smart Summary processed?
SmartSummary for claims processed the previous month generate between the 5th and 10th of the current month. Statements are mailed between the 10th and 30th of the month. Members receive their statements by the 10th of the following month.
What section can members set their preferred format via the Language & Accessibility drop down fields.
Communication preferences
What is used to order paper copies of Medicaid benefit information such as member handbooks, welcome kits, and provider directories.
Order Entry System (OES)
True or False:
PCP changes are made via the PCP Update/Change template in CRM.
True
What Call type should you take serious 100% of the time?
Crisis Calls
This process used when a member has more than one insurance plan.
Coordination of Benefits or (COB)
A common cause for lock outs is when members inadvertently leave the _____ key on.
Caps Lock
What type of member does not have a Humana member ID and must be documented in CRM as an unknown member.
A prospective member
When changing PCP, what color banner represents a successful change
Green Banner
What type of calls typically come through unauthenticated from a Centers for Medicare & Medicaid Services (CMS) and are made occasionally?
Test Calls.
Friendly Reminder: All advocates are the right person for them to contact regardless of their question; therefore, your response must always be “yes”.