VOB
How will you quote medical equipment?
DME (Durable Medical Equipment)
If a provider is calling and they need assistance with initiating an authorization for a procedure. Which department should you transfer?
Provider queue
What is the TAT for sending an ID card?
5-7 Days without delays
10-14 with delays
If the member wants to pay for their monthly premium. What are the payment methods that they can use?
Credit Card, Checking Account, Bank Account, Coupon Book % Social Security Account
If the member wants to dispute the LEP on her account, what are our options to assist the member?
Attestation and Reconsideration
If a member is asking how much is the copay for diabetic shoes, How will you quote this benefit to find its corresponding copay?
Diabetic Care > Diabetic Shoes
Do advanced imaging services require an authorization?
Yes
What is the TAT for medical authorization?
14 days
If the member has penalties on her account. What do you think that means?
She has a late enrollment penalty
How long is the grace period for the member to process an attestation and reconsideration?
90 Days since the initial letter date
60 Days starting from the date the Attestation expired.
How will you quote the procedure cataract surgery?
Surgery Services
Does Home Dialysis require an authorization?
No
What is the TAT for expedited authorizations?
72 hours
How many days can you advice the member to wait in case there are delays on their payment?
2-5 business days
How long is the processing time for Attestation and Reconsideration Request?
Attestation: 7-14 Days
Reconsideration: 90 Days
The member is asking if Humana offers a service to get a ride from her address to the Doctor's office. How will you quote this benefit?
Transportation
Which department processes the authorizations for medical services?
Clinical Intake Team (CIT)
What is the standard TAT for mail service?
7-14 days
If the member says that they paid their premium through their checking account and there are no payment that got through with Humana. What can you advise the member to do?
Ask them if their bank managed to clear the check and finished the transaction and how many days has passed by since that happened
How do we resolve the call if the member wishes to process a reconsideration?
Gather a sup tag and refer the member to the C2C Innovative Solutions Inc.
How do you quote injections?
First Ask probing questions and check where does it fall under.
Possible answers:
* Part D Medications
* Part B Medications
* Surgery Services
* Immunizations
* Vaccines
If the member's authorization was denied, Which department can you connect the member/provider to?
What is the TAT for the reconsideration to be finished?
90 Calendar Days
If the member claimed that they paid their premium, yet none shows on their account. What should you do?
Send the case to the billing department requesting for a payment recovery.