mentor
1.Medicare Advantage Prescription Drug (MAPD) Document Index
2. Pharmacy Medicaid and MMP Document Index
3. Indiana PathWays for Aging Calls Document Index
WHAT SYSTEM DO WE USE TO CHECK A MEMBER BALANCE
SOLUTRAN
there are 4 ways to get to CI what are they?
digbot
go/hod
ci/papi link in crm
and launchpad
where do i get to the claims in CRM
claim summary
what are the two systems for pharamcy
rx call connect
rx connect pro
WHAT MENTOR CAN I USE TO FIND OUT ABOUT THE INDIANA PATHAWAYS PLAN IN GENERAL?
Indiana PathWays for Aging Overview (humana.com)
what Ci screen do i need to be on to enter in an H number
umid
what probing questions can we ask if we are trying to locate claim
what is the dos?
what is the name of the dr?
what is the amt of the claim?
will u handle both medicare and medicaid pharmacy calls T/F
true
WHAT IS OUR MAGICAL NUMBER?
Humana Medicare DSNP H5619-054 plan
WHAT IS THE PIN NUMBER? AND CAN IT BE CHANGED?
IT IS THE LAST 4 OF THE CARD AND NO IT CANNOT BE CHANGED
what is pesl used for?
to locate a member and to get to their h number so you can continue in CRM
what is the allowed amt definifition?
the amt that the provider agrees to contractually accept from humana for taking in humana medicare
patients
what are the 4 stages in humana pharamacy medicare?
deductable initial coverage, coverage gap (donut hole) castrophic
WHAT TWO MENTORS WHO I USE IF WANTED TO KNOW IF THERE WERE ANY ON GOING ISSUES WITH MEDICAID OR MEDICARE
DO SPENDING ACCOUNT CARD BENEFITS ROLLOVER?
(TRICK QUESTION)
YES ONLY IF DEBUT SPECIFIES THAT IT DOES
do i have to patr when i do a demographic change in CI
if you do patr it dont matter
what is the letter of agreement?
The contract that the provider has with humana regarding processing claims and also states member cannot be balance billed.
how many tiers are in a medicare plan for pharmacy
5 sometimes 6
DESCRIBE THE THREE UNALIGNED STATUSES?
1.Unaligned (Humana Medicare DSNP H5619-054 plan and a Medicaid plan with a different insurance carrier)
2. Unaligned (Humana Medicaid plan and any other Humana Medicare plan)
3. Unaligned (Humana Medicaid plan and a Medicare plan from another carrier)
YES, IN SOLUTRAN IT DOES ALLOW FOR AN ALTERNATE ADDRESS
where can i find the power of attorney information in CI
paig
is it recommended to call the provider about a claim?
yes, we always want to help our agents. we want to match our member's pace.
what is LIS (extra help)
help with medications and to help lessen the burden of copays for meds