MEDICAL BENEFITS
WHERE DO YOU LOCATE MBERS BENEFITS
DEBUT
Member is calling to verify if we have received that request and to verify if it has been Approved, Denied , Pended or Voided.
Auth/Referral Authorization
Authorizations are for what
Based on medical necessity.
Required to get certain out-of-network services.
Not a guarantee of payment.
Used to identify the service, provider, and time-limitations.
WHAT DOES P.A.R.E STAND FOR?
Pathologist, Anesthesiologist, Radiologist and Emergency Room Physician
Member is calling because they need to know information about a specific benefit they have available and how they can used those benefits.
Benefits Verification
what is prior auth
Obtained from the health insurer before a service is rendered or a prescription is prescribed.
What are the three things you need to do on all benefit calls?
Verify the provider, check for authorization, and quote the benefit.
Member is calling to understand the transportation benefit.
Transportation Benefits
what is concurrent auth
Updated authorization that occurs when a change is needed to an existing authorization.
what are features of MyHumana Dashboard
Coverage, Claims, MyHealth, My Meds, Account
what are the cost sharing terms?
Deductible,Copay,Coinsurance
Member are calling because they need to speak with the nurse advice line or their care manager/coach/coordinator
Wellness Clinical Support
what is Retrospective authorization
Requested after the medical service, treatment, or test has been completed.
what is Multi-Factor Authentication
The 2-factor authentication process provides an extra layer of security by protecting the member's personal information and privacy during:
What is the difference between VAB and Reimbursable Benefits
VAB:Extra programs and services that are included in Humana's Healthy Horizons Medicaid plan. These benefits are offered by Humana not the state.
Reimbursable:Services that the member paid for. Humana simply reimburses the member upon the service being completed.
Member are calling about there rewards and incentives as well as general help finding go365 and the benefits for joining
Go365 Elig/Benefit/Program Questions
Shanice's member account page shows that she has a verification on file that confirms that she has benefits covering treatment for a kidney condition. What is the name of this type of verification?
Predetermination
what is needed for a First Time Call to Activate a Minor's Account
They must fax or mail 2 pieces of approved documentation to Humana (A letter of authority with the following required information,A letter of authority with the following required information