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What is a Late Enrollment Penalty?
a) Premium penalty for not having Part D coverage for 63 days or more
b) Premium penalty for not having Part B coverage for 63 days or more
c) A one-time penalty for those paying their premium late
a) Premium penalty for not having Part D coverage for 63 days or more.
If a member is dissatisfied with something other than a claim or authorization outcome,
how can they file a grievance?
a) Verbally over the phone
b) Verbally or online at Humana.com
c) Verbally, online at Humana.com, or on MyHumana.com
c) Verbally, online at Humana.com, or on MyHumana.com
How much time does a caller have to file a verbal or written grievance?
a) 7 days
b) 14 days
c) 30 days
d) 60 days
d) 60 days
If a Louisiana member calls on Jan 20th and reports that they are permanently moving
to California on the same day, when will their current plan terminate?
a) Jan 20th
b) Jan 31st
c) Dec 31st
d) The plan will not terminate.
b) Jan 31st
A member calls requesting an ID card. You check and see that their plan has a future effective date. What do you do?
a) Tell them it’ll take 7 to 10 business days to arrive, and then go to the ID Card
Management Tool and request a card for them.
b) Tell them only an electronic version of their ID Card is available at the moment
through the ID Card Center.
c) Tell them that an ID card isn’t available yet, but a proof of coverage document can be accessed in the ID Card Center.
d) Tell them that a Digital ID Card is available in the MyHumana app.
c) Tell them that an ID card isn’t available yet, but a proof of coverage document can be accessed in the ID Card Center.
How long is a member responsible for a Late Enrollment penalty?
a) It's a one-time fee
b) 6 months
c) Same length of time the member remains in the Coverage Gap
d) For as long as the member has a prescription drug plan, or until they qualify for
low income subsidy
d) For as long as the member has a prescription drug plan, or until they qualify for
low income subsidy
7) Which statement below is true:
a) Only the member can file a valid grievance.
b) Only the member and certain types of POA have the authority to file a valid
grievance.
c) The member and any type of POA have the authority to file a valid grievance.
d) Anyone can file a valid grievance.
b) Only the member and certain types of POA have the authority to file a valid grievance.
When is it appropriate to advise a member to contact SSA or CMS?
a) When unable to answer the member’s question
b) When directed to do so in Mentor
c) Only with leadership approval
d) Only when directed by Mentor (SSA) or with leadership approval (CMS)
d) Only when directed by Mentor (SSA) or with leadership approval (CMS)
When a death is reported, what organization must be contacted with the date of death
before Humana's system can be updated?
a) Social Security Administration (SSA)
b) Center for Medicare and Medicaid Services (CMS)
c) Internal Revenue Service (IRS)
a) Social Security Administration (SSA)
How many days can pass before demographics need to be verified again?
a) 30 days
b) 60 days
c) 90 days
d) 120 days
c) 90 days
Where in CRM can you update member preferences?
a) Person Account Page and Communications panel
b) Policy Member and Person Account Pages
c) Advocates do not update preferences
b) Policy Member and Person Account Pages
Which of the following is considered a Grievance (not a QAA complaint or appeal)?
a) “I got a bill for an x-ray that I never had! I’m not paying for that!”
b) “I think I’m allergic to this medication my doctor prescribed!”
c) “I can’t believe my premium has gone up again! I can’t afford this!”
c) “I can’t believe my premium has gone up again! I can’t afford this!”
When researching bank drafting issues, which one of the following questions do you NOT need to answer?
a) Does the member’s plan have a premium?
b) Is the member’s plan approved by CMS?
c) Has the member reached their deductible?
d) Is the member’s payment method listed and has it recently changed?
c) Has the member reached their deductible?
What is the EMME letter code for the Consent for Release PHI Letter?
a) ME2427
b) MD0366
c) MD0433
d) ME2231
a) ME2427
24) Which types of demographic change requires CMS corroboration?
a) Date of death / Date of birth / Medicare ID / Name / Gender
b) Date of death / Address / Phone number / eMail address
c) Date of death / Gender / Address / Phone number / Name
a) Date of death / Date of birth / Medicare ID / Name / Gender
How can you locate a Voice Automated Technology (VAT) call that a member states they received?
a) EMME
b) EMME and CRM
c) Softphone
d) EMME and OMS
b) EMME and CRM
Which of the following is considered a QAA complaint?
a) “This is annoying. I’ve been billed twice for the same service!”
b) “You know, I think my doctor hates me. He doesn’t even look me in the eye!”
c) “That automated answering service you have really stinks. It took forever for me to
get to a representative!”
b) “You know, I think my doctor hates me. He doesn’t even look me in the eye!”
In eBilling, a Coupon Book is requested for a member using which Payment sub-tab?
a) Make a Payment
b) Payment Accounts
c) Online Payment Activity
d) Payment Method History
d) Payment Method History
If a member asks for a replacement ID card, what one of the following does NOT need
to be checked first before processing the request?
a) Mailing address
b) Name of PCP
c) ID card status
d) Plan type
d) Plan type
A new Humana member attempting to access MyHumana says their computer is not responsive when clicking any of the links.
Which of the following would help to resolve this issue?
a) Warm transfer the call to Web Security.
b) Advise caller that there may be system issues and to try again in 24 hours
c) Advise caller they may need to enable cookies functionality
d) Advise caller they may need to replace their computer
e) Recommend they call the customer service line for their computer manufacturer
c) Advise caller they may need to enable cookies functionality
Where can you view a member's SmartSummary statement?
a) EMME
b) Order Management System (OMS)
c) CRM
d) CRM and EMME
d) CRM and EMME
When handling a Quality of Care or Attitude complaint, where is the case routed to?
a) CRM automatically routes to the Resolutions Team
b) Clinical Intake Team (CIT)
c) Advanced Resolutions Team
a) CRM automatically routes to the Resolutions Team
Humana typically bills members around the 20th of each month. When is the payment due?
a) The 1st of the next month
b) The last day of that same month
c) The 15th of the next month
d) The last day of the next month
16) If a Louisiana member calls on Jan 20th and reports that they are permanently moving
to California on the same day, when will their current plan terminate?
a) The 1st of the next month
20) What do Advocates use the ID Card Center for?
a) Requests for a new card.
b) Requests for an additional card.
c) Requests to add a Primary Care Physician to the card.
d) Guide members to view and/or print an electronic copy of their card
themselves.
d) Guide members to view and/or print an electronic copy of their card
27) Which statement regarding Web Emulation is true?
a) Advocates can guide members through the account activation process by using Web Emulation
b) A member must have an activated account for Web Emulation to work
c) Web Emulation can be used to assist members with Find a Doctor or Pharmacy
Finder
b) A member must have an activated account for Web Emulation to work