Customer Service Systems
What system do we pull up everyday to access HSS?
Digbot
What is the C/I for a member calling in wanting to locate a provider?
Provider/Locate
Are we able to set up a members myhumana account for them?
no
Which category button in Debut will you find routine benefits for an annual wellness check?
Preventive
What is the most common type of call Humana receives?
Unpaid claims
What system can we look up mbrs with their name dob and zipcode?
CI
What C/I would you use for an address change?
Demo/change
How do members with an activated MyHumana account sign in online?
Enter their Username, Password, and click Sign-in button.
Which of the following is considered a DME item?
Dentures
Sleep Apnea machine
Eyeglasses
Sleep Apnea machine
Who does a provider charge when Humana denies a medical claim?
The member
What is the main system we use for our calls
CRM
What C/I would you use for PCP change?
PCP Change/PCP change made
Confirmation codes are intended for one-time use. How long is a confirmation code valid?
5 minutes
Who offers value-added / expanded benefits to the member?
Humana.
What is an example of a physician interpretation denial?
A provider charges professional fees for lab services.
What do we use on CRM to make a case on every call?
QS
What C/I would you use for a MBR needing a new id card?
Fulfillment/ID card/access card request
When setting communication preferences in MyHumana.com, what section can members specify their written and spoken format?
Language & Accessibility
How are reimbursable benefits paid to the member?
Paid to the member after the member's appointment.
When can an ER claim be denied?
When requested medical records are not received.
What system do we use for RX?
Rx Nova
What C/I would you use for a mbr daughter calling and no consent on file?
HIPPA/not authorized
Members who want to block their information online can only block which individuals from view?
Everyone, including themselves
To locate benefits related to breast pumps, what two places would you check?
Pregnancy, Newborn, and Family Planning Overview for Medicaid Mentor document. and debut
When is a Notice of Adverse Benefit Determination (NOABD) sent to a member?
When a Medicaid or Long-Term Care (LTC) claim is partially or fully denied.