CRM Navigation
What page would you view on a member’s account when you are confirming demographics?
Person Account Page
What Services Requiring Prior Authorization?
What Term does your state use?
HNA, HRA, HRS
When sending member a provider listing from PFP, what email address can members expect the email to come from?
donotreply@humana.com
Who can verify/update demographics?
Member, legal guardian, POA
When wanting to view details of member’s coverage, what page do you navigate to in CRM?
Policy Member Page (Umbrella Page)
What is a referral?
A referral is a type of authorization that allows a member to be referred to a specialist.
What is Health Assessment?
True or False: A doctor can practice at several locations and ALL of them are INN with Humana.
False. A doctor can practice at several locations with some being INN and others being OON with Humana.
If members do not report their new address to the state, how long before the member’s plan is changed, or they are disenrolled by the state?
30 Days
If a member says they received a letter or call from Humana, where can you view it in CRM?
Communication panel on the right-hand side of CRM
True or False: You need an authorization for an annual wellness office visit?
False: You do not need an authorization
What does HNA stand for?
Health Needs Assessment
How many providers can you compare at one time using the Compare button?
3
In what circumstance can a residential address be Post Office box?
If the member is homeless or in a shelter, they can use a P.O. box as their residence.
When creating cases from QuickStart what page in CRM do you need to be on?
Policy Member page (Umbrella Page)
What is a prior Authorization?
A prior authorization is obtained from the health insurer before the member can fill the prescription, or have the medication administered in the doctor's office.
What does HRA stand for?
Health Risk Assessment
Why would we use PAAG?
If we can not find the doctor in PF and the member insist the doctor is in network
If a member is JUST changing a phone number, do they still have to contact the state agency?
Yes, to ensure it is a permanent change it must be reported to the state.
Where can you find the Medicaid ID in CRM?
Policy Member page under Member IDs at the bottom
What is a Concurrent Authorization?
This occurs when an update or change is needed to an existing authorization for services that are currently being received.
What does HRS stand for?
Health Risk Screening
What mentor would we use if we have to do a manual PCP change in CI?
Primary Care Physician Change in CI Medicaid and MMP
What screen in CI is used to create a task if we have to update the demographic change manually?
PATR