Medical Benefits
What tool would you use to locate the members benefits?
Does a member need a referral to see a otolaryngologist?
No
What can we never GIVE the member to assist them with signing in?
Username
What is the name of the mentor we have used in training that list all the mentors by category in alphabetical order?
Medicaid Calls Document Index
True or False: If a member ask not to be recorded we have to document that call.
True
If a member is calling about their dental benefits what would you quote?
Nothing. You would advise them to contact OHCA or their Dental carrier.
True or False: Humana handles all authorizations.
False
True or false: The username must contain at least 1 uppercase, 1 lowercase and 1 number?
False
From the Index what mentor would you start with for a Medical benefits call?
Verification of Benefits Medicaid and MMP Overview
How many times can a member attempt to put in their MyHumana.com password before it locks them out?
5 Times
What are the base services that are covered with Personal Care?
Services include but are not limited to, assistance with:
If a member already had services performed and are inquiring if they can submit an authorization for these services, what would you advise?
Yes they can, it is called a Retro Authorization.
What three Humana websites can member navigate securely?
Answer: Humana.com, Go365.com, and HumanaPharmacy.com
What is the mentor for Oklahoma phone numbers?
Oklahoma Medicaid Phone Numbers
What are 3 things other then the members full name needed to authenticate the member?
What are the expanded benefits for OTC?
Up to $30 per household per quarter allowance enables households to purchase products that support common occurring conditions such as:
What three ways can a provider submit an authorization or referral to Humana?
Provider Web Specialist, Phone, Fax
If a member is needing their password reset what tool will you use?
CSR PasswordReset
What is the state specific mentor for Oklahoma when it comes to Eligibility calls?
Eligibility Verification and Access to Care for Oklahoma Medicaid
Before mailing out a new ID card what are 2 things that you have to verify?
Address and PCP
What are the exclusions for Telehealth services per Debut?
Exclusions
Not covered: Physical therapy, occupational therapy, and/or speech and hearing services as a part of telehealth
Using the mentor: Medical Authorization and Referral Calls Florida Medicaid, If a member calls in to check status of an authorization what step do we go to after step 1?
Go to the Status Calls section.
What are the 4 different characters the member can use in their myhumana.com password?
May include the following characters: #, $, *, or @
What is the mentor that we use for guidance with the Digital Onboarding Experience?
MyHumana Account Setup - Digital Onboarding Experience
What are the PARE providers?
P-athologist
A-nesthesiologist
R-adiologist
E-R Physicians