Systems
This system is used to check for medical, dental, and other insurance benefits.
what is Debut
Anyone can access this to learn about the Company, it's plan offering, and educational information about Medicare/Medicaid
What is Humana.com
When a call comes in through this, advocates access the member's account in order to assist the caller.
What is the Softphone
This is a legal document signed by a member to allow another party to act on a member’s behalf.
What is a Power of attorney (POA)
Members needing help shopping for Medicare plans are connected to this team for a licensed agent to further assist.
What is the DMS team
This system is used to check for claims in depth
What is CAS
This app is available for members to access on their mobile phones to manage many areas of their healthcare including medical coverage, prescription information, finding a doctor, and viewing their medical ID card.
What is the MyHumana Mobile App
This is the second tool that is used on every call. It's used to document details specific to the caller's issue or concern.
What is is QuickStart+
Humana must receive this signed by the member, adult dependent, emancipated minor, a parent, or legal custodian of a minor dependent in order to disclose a member’s PHI.
What is a consent form
the Annual Enrollment Period (AEP) occurs between THESE DATES annually. This is when Medicare beneficiaries get to decide if they want to keep their current coverage, switch plans, or switch insurance carriers altogether.
What is October 15th and December 7th.
This system is used to check for providers to see if there in network and accepting new patients
What is Findcare
This is a search engine that allows you to locate internal guidelines relevant to your role. This is also used throughout training and during live calls to reference call handling procedures.
What is Mentor
This provides a complete view of each member account by compiling information from over fifteen Humana systems.
What is The Customer Relationship Management (CRM) Service application.
The final permission method for sharing PHI is typically offered to a member's spouse, friend, or family member calling on their behalf. The member can provide this if they’re available to speak with at the time of the call.
What is verbal consent
The MA Annual Open Enrollment Period (OEP) occurs from THESE DATES. It allows individuals enrolled in a Medicare Advantage plan to make a one-time election during the first 3 months of the calendar year to switch Medicare Advantage plans or to disenroll from a Medicare Advantage plan and return to Original Medicare.
WHAT IS January 1 through March 31.
This is another system that communicates directly with Customer Relationship Management (CRM).
What is Customer Interface (CI)
Logging in to this is a part of every advocate’s daily setup. This also allows you to quickly navigate to the other systems.
What is the DIG Toolbar
In most cases when handling live calls, member information automatically displays in this to verify with callers.
What is the Member Search tab
Understanding what this is and key behaviors to look for are essential for safeguarding the sensitive information our members entrust us with.
What is a bad actor
To enroll in this, a person must:
Have Medicare Part A & Part B (at the time of enrollment or will have within the next 3 months.)
Live in the plan’s service area.
In addition, to the above they must also have an enrollment period available to make a plan selection.
What is a Medicare Advantage plan.
If the member cannot be found using any search option, document the call this.
What is an unknown member
This is our scripted greeting for humana calls. This is our scripted end statement for humana calls
What is "Thank you for calling Humana. My name is ___________, your healthcare advocate. How may I help you? " and "It's been a pleasure helping you with (the reason for the call). Thank you for calling Humana, we're always here to help."