Customer Service Fundamentals
What is the Clas/Intent for a member requesting an ID Card
Fulfillment/ID Request
What i the name of the tool used to quote member benefits
DEBUT
What 2 systems can you load Find Care from?
CRM and Debut
What is the name of a stand alone rx plan
PDP
What is the name of the system that you log into daily? What TWO boxes do we check when logging into the system?
DIGBOT, CRM EDGE/CI
What POA Type must a mbr respresentative have before they can make a demographic change?
C, H, or O
WHAT DOES DME STANDS FOR?
Durable Medical Equipment
What is the name of the mentor doc that you will use for a HMO PCP change?
Primary Care Physician Changes for HMO Medicare
How many benefit stages are there
3
deductible
Initial Coverage
Catastrophic
What are the factors needed to FULLY authenticate a member?
How long are any of the rest allowed to be temporarily out of the service are?
6 months
What are the MEDICAL types of policies Humana carries
HMO Plan
PPO Plan
T OR F PCP'S ARE ALWAYS AUTO ASSIGNED TO NEW MBERS
FALSE
what is LIS and where can we see if a mber has it?
EXTRA HELP/ DEBUT AND CRM
Where in CRM can we find the POA and Consent Forms?
Person Account Page under HIPAA
How long is a member with a PPO and PDP allowed to be temporarily out of the service area with an address change?
12 months
What i the difference between the HMO and PPO
HMO Plan- Referrals may be required
PPO Plan- Referrals not required
What is the name of the systems to locate providers
FIND CARE AND PAAG
What are the two types of OTC Benefits
Mail Order and Spending Card
Other than Mentor what are we REQUIRED to use on every call?
QS+
hen a member is deceased what replaces the POA?
Mber calls and wants to know if an injection is covered, what would you quote from DEBUT?
PART B PHARMACY AND SURGERY
T OR F When changing a mbers PCP they can go into effect the same date of the change
FALSE.
What system do we use to check the mber benefit stage and what system is used to check rx claims?
RX Connect and RX Nova