Random 1
Who is eligible for Medicare?
65 years and older
End-Stage of Renal Disease
"Today I went to the doctor providing my Humana ID and the receptionist told me the card was out of date"
Eligibility :: Verification
Who makes OI updates in Humana's system?
COB Team
What tool is used for new or additional ID card requests?
ID Card Management
"I need knee surgery, does my plan cover that?"
Benefits :: Verification
Is the main application you will use to assist members because it allows you to access systems:
DIG Toolbar
True or false: Termed members can schedule medical care and obtain prescriptions with Humana's coverage.
False
When do you have to complete the OI Template?
When a COB discrepancy is identified
What are the types of notification a Humana member can receive?
Letters/Forms
Emails
VAT Phone Calls
"I want to report how the pharmacy employees treat me the other day."
Complaints or Compliments :: QAA
Which interaction button will you use if the member's representative, Power Of Attorney or pharmacy is calling?
Interaction About
When placing an OMS order, you must identify:
Contract #
PBP Code
Segment ID
What should you do if PAAG shows the requested provider is out of network?
Help the member find another doctor that is in-network
When caller refuses your assistance and ask for an onshore person, you transfer the CRM case directly to:
Escalated Caller Member Solutions Team
"How much it will cost me if I schedule a trip to my doctor's office?"
Transportation :: Benefits
What are the pieces of information you can ask to authenticate members?
Member's ID (H#)
Date of Birth
Zip Code
What tool is used for new or additional ID card requests?
ID Card Management
True or False : SmartSummaries and outbound VAT calls placed are viewable in CRM?
True
What is included on the SmartSummary?
Claim Details
Rx Drug Details
Cost Share amounts
"Do I have Silver Sneaker program included in my plan?"
Benefits :: Rewards
What are the eligibility details you need to check in CRM Service to identify a member's coverage?
Effective date
Member ID#
Term date
What of the following is not a policy status indicator?
Active
Future
Termed
What is a Grievance?
Humana doesn't meet member's expectations
Is a cost-saving measure that prevents members from receiving duplicate benefits when they have multiple insurance plans
Coordination of Benefits
"My last name is with double N. I want this corrected now"
Demographic :: Change