TRUE/FALSE
You aux meals for lunch in genesys
FALSE! always LOG OFF for lunch
what mentor is needed when quoting benefits?
IN PathWays for Aging Comprehensive Benefit Grid
What mentor is needed when needing guidance on EX Codes?
EX Code Guide CCC Provider
What mentor is needed to fully comply with HIPAA?
HIPAA Overview CCC Provider
Do we have to create a case on every call? Even if the call drops?
YES! even if the provider hangs up or nobody's on the line, we must create a case for it! This would be known as a "ghost call"
We use PAAG to check provider contract info/credentialing!
TRUE!
What is the member copay for home health?
$0 copay as long as the home health provider is INN with members plan
You need to access a claim located in crm, how do you get there?
1. Access Umbrella Page
2. Use quick links at the top and access CLAIM SUMMARY tab
List 3 examples of PHI
Provider is needing to know if they are IN NETWORK, what 2 systems will show you this?
go/pfp PHYSICAN FINDER PLUS
go/paag PROVIDER AT A GLANCE
DUAL means the member ONLY has medicaid
FALSE! Dual means member has Medicare AND Medicaid combined
Per the benefit grid, what is the Base Age Limit for Home Health?
60 and older!
Provider is needing to know how much Humana paid on a claim, you see the claim is currently PENDED, what do you tell the provider?
Inform the provider the claim is currently still processing, do NOT release info until the claim has a denied or paid status.
To start the call in CRM, who do you authenticate first? Member or Provider?
ALWAYS authenticate the provider first, choose your interacting with, then move onto the member authentication and choose interacting about!
what's the MAIN self-service website our providers use?
Availity Overview CCC Provider
PLEASE make sure to save this, you will need it on calls
Physican finder shows us the members INN pharmacies!
FALSE! go/pfp shows us the members INN providers!
What is EXCLUDED from home health benefits?
* Homemaker, chore services, and sitter/companion services
* Educational activities such as the remediation of learning disabilities
You are on the claim summary tab in crm, you need more info than what crm is giving you on the first page. How do you get more info within the claim summary tab?
Click the claim number hyperlink in blue to open the claim up fully!
Provider on the line is needing to verify the members current pcp on file, however they are not able to fully authenticate the member. Do you still release the info?
NO! We can't release ANY member info until the provider fully authenticates the member they are calling for.
Provider is needing to Join The Network, what mentor tells you how to do this?
Provider Issues CCC Provider
*Remember- always send these from your humana email ( go/email ) and never cc the provider on it!
You can ALWAYS take hour long lunches even in production
FALSE! Go based off your WFO, (30min lunch)
What is the website that shows us government / state funded programs in the members area?
*hint hint* rhymes with ERTHA
You come across a claim EX Code 49U, what is the description for that code?
Payment Is Not Allowed For This Service Because The Professional Component Billed Is Missing The Required Revenue Code. A Corrected Claim Can Be Submitted To The Claims Address On The Back Of The Member's Id Card With The Required Revenue Code For Review. The Member Is Not Responsible For Payment.
You are needing to create your case in CRM, what button in quickstart do you click to do this?
Associate to policy! Once you click this all you have to do from there is close your case!
Provider is wanting to confirm if an auth has been approved yet, how do you find this?
In CRM go to Umbrella Page, at the top Quick Links search AUTHORIZATION/REFERRAL SUMMARY tab!