CI
What do you do if the SSN is red in CI?
Go to the PAAL screen
When do we offer to send the disenrollment forms through email?
Last four days of the month
What is always "X" for a cancellation of enrollment?
Election Type Code (ETC)
If a member calls in and says "I never enrolled into this Humana plan" and its PAST the effective date. What should you do?
File a Section A and WT the member to DECT
What do you do if the member is unknown at the time of the call?
Create an unknown member case and pend the case until workable.
What screen do you check in CI to see if the TS is workable?
PAIG
Where can we see if and why the member was denied a disenrollment?
Case history
(Case history will show you why a members disenrollment form was denied)
Once you have verified the member is in CRM, the policy is active in CI, where must you also check to make sure the policy is active?
MARX
What does ERC of 107 mean?
Member has enrolled into a non-Humana plan.
Other than CRM, where can you see if the member has LIS and what quarter has been used?
MARX
If the member is known but the future policy is not in CRM, where can you find the contract/PBP code at in CI?
IPBD Screen
Go through the SEP questions with the member to determinate if they have a valid SEP to disenroll.
What do you do if the member is a known, the policy is in CI with a TS of 00/55/04/99 with NO end date but is not showing in Marx?
You can process a cancellation with a TS of 00/55/04/99.
If a member calls in and says they submitted an application the day before and you aren't able to locate the member or any enrollments, where can you check this information?
Fastapp
When we have to create a letter to send to the member, where do we create the letter?
EMME
On what screen in CI can you see if the member has a OSB?
POSB screen
When do we add Mets to a disenrollment call?
If we are emailing the member disenrollment forms and if we are sending the disenrollment forms through the mail.
After a case has been pending for four days and the TS is still not workable, what do you do?
Send the case to our ancillary team for review.
How do you know if the member has been enrolled into an Auto Assigned PDP policy?
Humana Enrollment Source will be-
C
A
R
H
What type of POA can make plan changes?
POA type U
POA type H
POA Tyle C
When do you process a cancellation in the MAINTENANCE FIELD on the PACT screen in CI?
If the TS is 00/50/04/99
What are the different methods a member can submit disenrollment forms?
1. Complete and submit the forms online via Humana.com
2. Write their own request.
3.Print the disenrollment forms online.
4. Receive the disenrollment form by mail.
If the member calls in to cancel out the future enrollment but Marx shows the future policy starting 04/01/2024 and has an end date of 04/30/2024. What do we do?
Follow Medicare Plan Cancellation Calls under step 7- "has a future term date."
Create a Patr, update the TS to 27, update the comments in crm and transfer the case.
When processing a cancellation of cancellation request and the TS is workable, what do you update the TS to?
04
If a member calls in and they are screaming, using inappropriate language, threatening you and or Humana. Where do you send the member?
Abusive Caller line, 1350151 (Warm transfer)