Medical Basic Benefits
Debut
Authorization & Referral
Additional Benefits
Random True or False
100

What is the difference between preventive and diagnostic services? 

preventive services are the ones member uses to help stay healthy, prevents illness or detect illness early. Diagnostic services are the ones member uses to identify the cause of symptoms or threat the illness. 

100

In what tab of debut do you find the copay and vendor for transportation?

transportation tab

100

What is the difference between authorization and referral? 

authorization is for medical procedures or equipment and a referral is for a medical visit. 

100

What are additional benefits not covered by original medicare, but covered by medicare advantage part c?

Vision, dental & hearing.

100

True or False:

Do you make the eligibility survey with the member to get the spending card benefit?

True

200

Ancillary providers ( PARE) are Pathologists, Anesthesiologist, ________, emergency room physicians. 

Radiologists. 

200

In what tab of debut do you find the benefit for over the counter allowance?

OTC tab

200

What are the authorization status?

Approved, denied, partially denied, pending and voided

200

What is the humana wellness and incentive program called?

Go365

200

True or False:

All plans have the otc benefit. 

False

300

What is deductible, copay and coinsurance?

Deductible: amount member must pay out of their own pocket before humana will pay any expenses.

Copay: fixed amount defines in the insurance plan and paid by a member each time specific medical services are provided

Coinsurance: Money or percentage that an individual is required to pay for services after a deductible has been paid.

300

In what tab of debut do you find the copay for and MRI? 

Radiology tab

300

Provide word choice when the status of an authorization is denied with not medically necessary code. 

positive word choice

300

Can you mention a hearing and vision vendor? 

eyemed & truhearing

300

True or False:

You handle go365 related calls. 

false

400

What is the VOB cycle ( perfect call cycle)?

Quote the benefit -- Locate the provider  --- locate if an authorization or referral is needed. 

400

In what tab of debut do you find the copay for an injection medication part b?

pharmacy tab

400

Practiceeee:

Locate in referral guidance tool a stat that requires a referral from pcp.

varios states

400

What is the name and what covers humana fitness program?

silversneakers includes membership to thousands of network fitness locations nation wide. 

400

True or False:

We use C/I misrouted call/ transfer to correct skill, when we transfer the call to other department or tier level?  

FAAAALLLSEEEEEEE

500

Describe the post acute care services:  inpatient rehab facility, skilled nursing facility, home health care and hospice.

inpatient rehab facility: member stays to get therapy at least 3 hours per day

skilled nursing facility: member need 24h help cant do therapy 3 hours a day.

home health care: medical care delivered in patient home, does not required 24h care

hospice: care and support people in the final phase of terminal illness. 

500

Where can we find additional help for members in their communities?

Humana community navigator

500

practiceee

How would you quote Nuclear medicine: quote the benefit, locate if authorization is needed and locate a provider.

practiceee

500

Explain the 3 spending card allowances. 

Humana helthy option: this allowance can be use to purchase food, pay bills, routine transportation, pet care and more.

Humana flex allowance: is used to pay dental, vision and hearing services. 

Over the counter allowance: is used to buy over the counter item, this are medical item that are sale with out a medical prescription. 

500

True or False:

Being below the poverty line income makes an American qualifies to Medicare. 

Falseeeeee 

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