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 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
On alerts, if the member is not interested in the alert, or is not applicable to the member. What is the action that you will select for the alert?
Term
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 lat enrollment penalty
How do we add the member to the DNC List?
Quicklink VAT Do not Call list & Suppression
How will you quote the procedure cataract surgery?
Surgery Services
Does Home Dialysis require an authorization?
No
What is the TAT for expedited medical authorization?
72 hours
How many days can you advice the member to wait in case there are delays on their payment?
2-5 business days
If the member wants to dispute the other insurance on their account. Where can we find the Other insurance template to fill out?
CRM Case Edit page
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
If the member wishes to dispute the LEP amount on their account. What are the processes that we can do to assist the member?
Attestation and Reconsideration
How do you quote injection? Provide as many as possible
may change based on the scenario
possible answers:
* Surgery
* Immunization
* Part B Medications
* Part D Medications
* Vaccines
If the member's authorization was denied, Which department can you connect the member/provider to?
What is the TAT for Grievance?
Up to 30 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.
If the member said that the name on their ID Card should have a Suffix (Sr., Jr., II, III, etc.) on it. How can we assist this member?
If there is no suffix on crm, check on wipro if they have a suffix on the CMS records, if it matches on wipro perform a demographic change and add the suffix if not refer the member to SSA. Once done perform an ID Card request so that they receive the new id card with a suffix on it.