Enrollment
Please describe Enrollment.
Process.
How eligible individuals become Humana members.
OMS/OES. What does Medicaid use?
OES Product Code.
Plan terminations are a decision made to end a member’s healthcare coverage. Terminating coverage can be the result of an intentional (voluntary) decision made by the member, or involuntary (not by choice).
What Classification and Intent would you select for Termination related calls?
All termination related calls are documented in QuickStart+ as follows:
Classification: Eligibility
Intent: Term/Cancel Member
Checkpoint 1: Customer Relationship Management (CRM).
Checkpoint 2: Customer Interface (CI)
Checkpoint 3: Automated Enrollment (AE)
Qualification.
An individual's status determining their ability to enroll and keep their Humana plan.
Disenrollments are terminations requested on or after the plan's effective date.
Past due balances for deceased members are not the responsibility of the member’s estate, nor the Executor Of Estate (EOE). All past due premiums are waived.
OMS/OES. What does Medicare use?
OMS Form Number
True or False:
The Enrollment Member Search includes a Social Security Number (SSN) option. Healthcare Advocates may request the member's SSN.
The Enrollment Member Search includes a Social Security Number (SSN) option. Remember we never ask a caller for their SSN! SSN’s can only be used as search criteria when freely offered.
Medicaid. What mentor would you use to confirm which callers are authorized to request disenrollment.
Medicare. What mentor would you use to confirm which callers are authorized to request disenrollment.
Medicare: Who can Request?
Medicaid: Who can Request Disenrollment?
When would a member call with questions about their plan being terminated and request their policy be reactivated?
If they received a Member Termination Letter
Telephonic Signature: This means the member completed and signed an application over the phone through the fastApp application.
IVR: This means enrollment was confirmed through the Interactive Voice Response (IVR) system.
Wet Signature: This means the member received a pre-filled copy of the enrollment application without a signature that was later signed by the applicant and submitted for processing.
Digital Signature: This means the member signed the enrollment application through a digital signature pad in a face-to-face meeting with an agent.
Electronic Signature: This means the member completed the application and signed it online. The member normally receives an email with a link to sign the application electronically.
Unsigned: This means the individual who filled out the electronic application (member or agent) did not select a signature method to complete the enrollment. This is important because, without the signature, the application will not enter the AE system meaning the enrollment cannot be processed.
Wipro is accessed from CRM, through the DIG Toolbar, or Mentor.
What Classification and Intent would you select for Cancellation/Termination related calls?
Cancellation/Termination related calls are documented in QuickStart+ as follows:
Classification: Enrollment
Intent: Disenrollment
When reviewing a members account page, how can you tell if the plan is currently active or terminated?
Green dot will reflect active plan; also have the word Active.
Red dot will reflect termed plan; also have the word Termed.
What can delay the processing time?
Enrollment applications that are received late or incomplete can delay the processing time.
True or False:
If members don't complete the redetermination process in time, they will be charged a penalty.
False.
If members don't complete the redetermination process in time, they risk losing their Medicaid benefits.
Cancellation: Terminations requested prior to the plan's effective date. It does not require an available election period.
Disenrollment: Terminations requested on or after the plan's effective date. A valid election period must be in place to terminate coverage.
When a member has multiple terminated plans on record with Humana, you will need to access the ____ screen first prior to locating the termination reason on the ____ screen.
When a member has multiple terminated plans on record with Humana, you will need to access the PAAL screen first prior to locating the termination reason on the PAPI screen.