Fulfillment & Communication
What is the 2 places you can send a Humana ID Card
1. ID Card Management from CRM
2. ID Card Center from HI Page
Member is upset by the automated system; will this be a grievance or an appeal?
Grievance!
What systems allows us to see who's INN?
Physican Finder Plus! PFP
Member is needing an accurate pricing on dentures, what will you do?
Transfer to Dental Dep
Member is calling to see why she got a $500 bill from urgent care, can you help with this issue?
No, you would transfer to Medical Claims Dep.
What 2 places will show you when a letter was mailed out?
1. EMME (CRM or HI Page)
2. Communication Panel in CRM
Member is very mad about how the claim was paid, is this an appeal or grievance?
Appeal!
What system can we check the credentialing info for doctors if not found in PFP?
Member is needing to update phone number on her account, where can you do this?
Once you associate your QS to CRM, on the right-hand side you will select the Update Demographics tool!
Member wants to know her copay for Eliquis 5mg, can you help with this?
No, transfer to Medical Benefits.
Member is requesting a new Humana ID Card to be sent, what is the correct C/I for this call?
Classification: Fulfillment
Intent: ID Card/ Access Card Request
Member wants to make a premium payment, what system allows you to do this?
Ebilling!
Member is needing to update her PCP however upon checking PFP, you see the dr is OON, can we still make this change?
No, we can only update INN PCPs!
The dr can call the provider relations dep to get recredentialed
Member moved from NY to TX, what is the 2 things you will do here?
1. Update the member's address
2. WT DMS to get plan in new state
Members sister is calling to verify which PCP is on file, there is NO poa or consent on file, can you help her with this question?
No. We need POA or Consent on file. We can obtain verbal consent from the member, once that is obtained, we can mail the consent form from emme OR walk through how to do it online!
Member is requesting an OTC Catalog, what is the correct C/I for this call?
Classification: Fulfillment
Intent: Letter/Form Request
Member says if her appeal isn't approved / overturned, it will be life threatening, what do you do here?
WT to Expedited Appeal team!
If a member called to update a PCP on 10/20, when will this become effective?
11/1 !
Member needs her mailing address changed to a PO Box, can we make this change?
Yes! We will need to first verify the correct residential address, then verify the correct PO Box and update the mailing address only!
Member lost her Spending Account Card, can we send a new one?
No, transfer to Duals Dep.
Member is needing to go over her SmartSummary, where will you find this AND what is the C/I for this call?
You can find the S.S in 2 places:
1. Communication Panel in CRM
2. EMME (HI Page or CRM)
Correct C/I will be Communication / SmartSummary
What are the 4 most common payment methods for premiums?
1. SSA / RR
2. CC / DC
3. Checking or Savings Account
4. Coupon Book
If you are unable to update a PCP in CRM, what is a backup way to update this?
DIGBOT!
What happens if a mbr moves OOSA and does NOT update plan to the new state?
Members plan will be termed if they do not get a plan in the new area! It is VERY important to WT to DMS if mbr moves OOSA.
Provider is on the line calling to verify codes for billing, can we help?
No, transfer to the provider line.