Enter Title

PCP changes

100

Can be retro-changed back to the first of the month at any time.

Non-Newborns - Regions 1–8

200

How to Make a Change

 • PCP changes can be made by:

- Phone

- Web chat

- Online using the MyHumana Change PCP Tool

300

Change was successful: Advise the caller of the following: 

• • The ID card is viewable from the MyHumana account within 48-72 hours.
• • New ID cards and a PCP change letter confirming the change are received within 5-7 days.
• • The only visible change on the ID card is the PCP's name and contact information.
• • Once you receive your new card, throw away the old card.

400

The following criteria must be met to retro-date the PCP back to the newborn's date of birth:

• • The primary care physician is available for assignment.
• • The request is made within 30 days of the date of birth.
• • Non-NICU only: There aren't other primary care physician claims on file since the date of birth.
• • NICU Newborns only: A newborn in the NICU may have hospital or specialist claims on file.

500

Who can make a change

•  The following people can make updates for the member:
• - Legal guardian
• - Member representative with HIPAA authentication
• - Care Managers or Care Coordinators for members or foster care state workers.
• - Customer Care Specialists like the following:
• ○ Humana Personal Nurse
• ○ Humana Market Representative

Expanded and Reimbursable Benefits

100

 Assurance handles the following

Smartphone/Affordable Connectivity Program

200

This benefit is for ages 21 and over and includes 1 box with 10 meals per year

Home Delivered meals

300

If a member has Medicaid as Secondary

Care Managements isn't available to member whose Medicaid plan is secondary. A Digital Blood pressure Cuff or weight scale

400

We would review this system to see if the member has already exhausted their housing benefits

 QuickBase - Expanded Benefits Request tool

- If there's no information in the QuickBase PowerBI tool, review CGX tasks

500

Humana Beginnings team handles this request

What is Doula Services

COB

100

  Classification and Intent for Rx denial 090 Error 

• Classification: COB
• • Intent: Rx - 090 Denial

200

Time frame for OI Team to review request

 It can take up to 14 days for the Coordination of Benefits team to complete the review.

300

What screen in CI is utilized to determine whether a member has other health insurance coverage

CRI Screen

400

If a member is experiencing ATC issues your case is update to this

Update the case to critical priority.

500

Types of Insurance with which Humana Medicaid Doesn't Coordinate Benefits

•  Dental plans
•  Workers' compensation
•  School sports insurance
•  Go365 standalone plans

GENERAL

100

When providers charge patients for covered services more than their contracted or allowed rates.

Balance Billing 

200

When emailing a list of providers with the Share link the email is sent immediately from 

[e-mail]

300

Members can obtain an OTC catalog and form in the following ways

•  Online on Humana.com
•  Call CenterWell Pharmacy
•  Advocates can mail the form via:OES 

400

Tool utilized to assist members with Myhumana.com issues

Digital Access Manager/DAM Tool

500

If a member requests a Welcome Kit this process must be followed

• Create a follow-up task in CRM with a 24-hour turnaround time.
• .
• Refer to Notification Task Creation in CRM or QuickStart.
• .
• e. Route the task to your leader or a back-up leader.

Mentor

100

Medicaid advocates use the following table for links to frequently used documents.

Medicaid Calls Document Index

200

Third party that contacts Florida and Kentucky Medicaid members that can qualify for Social Security disability benefit

Centauri Calls Medicaid

300

Provides information on general communications that:  Are sent to Medicaid members; Occurred in the past 6 months; Generally occur once.

Member Outbound Communications Medicaid and MMP

400

Follow these steps for handling a call from a Medicaid member who is reporting a pregnancy or birth of a child.

Pregnancy or Newborn Notification for Medicaid

500

Call Advocates use this document when callers express concerns about: Financial struggles; Housing or homelessness; Food insecurity; Loneliness or isolation; Addiction; Other hardships

Social Determinants of Health (SDoH) Needs Medicaid and MMP