Mentor
Which Mentor is the starting point for HIPAA?
HIPAA Overview
What elements do we need from EVERY caller?
Member UMID, Name, DOB, & Zip Code
Is this the mentor we would use if a member was unable to speak for themselves?
HIPAA Job Aid Consent Form Special Circumstances Scenarios
Where can EOE send EOE information to?
Mail:
- Humana Medicare Policy Services
P.O. Box 14168Lexington KY 40512-4168
Fax: 1-800-633-8188 (Attention: Power of Attorney)
Which Mentor is used when Indvidual's call on behalf of the member?
HIPAA Job Aid Member or Individuals
What can be disclosed with anyone?
General Information, Eligibility/Enrollment, & Verification of Benefits
When would we use the HIPAA Job Aid Consent Form Special Circumstances Scenarios mentor?
The member’s current spouse not on the member’s plan is requesting protected health information on underage dependents on the policy
The dependent child under the age of 18 is set up as the policyholder for the plan.
The individual requests member PHI on an incapacitated or incoherent member (member is unable to speak for themselves).
The member resides in Florida and is incapacitated and did not previously execute a POA before becoming incapacitated
Visually impaired members who have challenges due to their inability to read the numbers on their unique member ID card.
What elements can be used for Authorization status?
Which Mentor do we use if a pharmacist calls on behalf of a member?
HIPAA Job Aid Provider and Pharmacy
Can we provide the member with their MyHumana Username?
No
What are some examples of members being unable to speak for themselves?
What information is needed for member rep getting paid claim info?
DOS, Provider Name, or Claim Number, and Member resp, billed charges, total amount paid, charge amount by line item, or paid amount by line item
Which Mentor do we use if a retirement groups rep calls on behalf of member? Ex: A labor first rep that we can search with their User ID
HIPAA Job Aid Internal Associate
If there is a consent form on file, what can we disclose?
All PHI pertaining to the member can be disclosed to the personal representative after authentication.
If a caller is authenticated and a member has Alzheimer's, Can we assist the caller with PHI related information?
Yes
What alternatives can be used if caller doesn't have UMID?
Medicare ID #, Payment ID #, or SSN
Which Mentor do we use if a member is unable to speak for themselves?
HIPAA Job Aid Consent Form Special Circumstances Scenarios
No
Do we follow normal ATC process if caller is authenticated and member is unable to speak?
Yes
In what situation can we provide the member with their UMID?
None - Beginning June 18,2024, Humana policy will prohibit advocates from providing the Humana ID on member calls and member web chats.