Enter Title

BENEFITS

100

Provide 3 of the 5 things you have to gather from a member to complete the VOB Checklist on a benefits call?

• The plan type

• The benefit requested is available

• The provider's network

• Accumulations

• If an authorization or referral is needed

200

What the difference of an HMO and a PPO policy?

HMO members have to go to in-network providers for coverages and PPO plan members allows in and out of network providers 

300

what's the name of the Excel file that determine preauthorization requirements?

Humana Customer Care Preauthorization and Notification List

400

What mentor document will you use to verify how to quote a benefit on DEBU tool?

Verification of Benefits Table of Contents

500

The member is calling to verify coverages on a massage chair how would you quote the benefit and confirm its covered?

you can quote it as a Durable Medical Equipment and with the CMS280.1 list is not covered. 

PHARMACY

100

What is the mentor document that you will need to handle a Pharmacy call step by step when the member is inquiring the copayment of a medication. 

General Drug Verification of Benefits for Medicare

200

What is the name of the mentor document that you need to verify why a claim was denied in RXNOVA

Actions for RxNova Error Codes

300

what medication information is required on Prompt PA to start the authorization?

• Drug name
• Strength
• Dosage
• Quantity
• Days supply

400

When a member quote that "they don't have the money to pay a high copayment for the medication". What other options can we provide to the member?

 Extra Help (LIS)

Medicare Savings Program

Manufacturer's Pharmaceutical Assistance Programs

Humana Community Navigator:  

500

The member is calling because he is being prescribe Wegovy medication, but the pharmacy is giving them the Denial error code 090. What will you inform the member and the mentor document to follow?

090: Submit Claim to Primary payer
Update Medicare Pharmacy Other Insurance.

RANDOM

100

What is the main tool to check for an authorization status for medical

CRM, Authorization/referral summary

200

What it's the process to follow when a member is changing the address and we received the OSA notification on demographic template?

• Tell the member that the new address is out of the service area.
• b. Advise the member:
• • Their plan terminates at the end of the month when the changes are made. Provide plan termination date back to the caller.
• • They must enroll into a plan in the new service area to prevent a lapse in coverage
• c. Enter the plan termination date (MM/DD/YYYY) in the Date Plan Will Terminate field.
• d. Select Yes, in the Was the member advised of their plan termination date field.

300

Member is calling to check how much he is being charge for a procedure of a knee surgery. he had on last month, how would you quote that benefit?

That's a claim, you transfeeeerrr!

400

What is the mentor document for you to guide a member on activating their humana account online?

 Account Activation for Members

500

The member is trying to create a password for their humana account online. What are some of the requirements that you need to provide for the member?

• Must be 12 or more characters
• • Can't contain spaces or punctuation
• • Have both letters and numbers
• • Include at least 1 capital letter and 1 lowercase letter
• • No other special characters aside from: #, *, $, or @.
• • Not mention a name, email or the username
• • Not contain a character repeated 3 or more times in a row.