Participating Providers
A member calls in and asks for assistance with locating a Urologist, the Classification & Intent you would select is?
What is
Classification: Provider
Intent: Locate
This is the process by which a health plan reviews and approves a specific medical service, procedure, or medication before it is provided to ensure it is medically necessary and covered.
What is Authorization (or preauthorization)
Three Cost Sharing Terminologies
What is Deductible, Copay, Coinsurance
Or OOP, maximum OOP cost
This mentor document is used to assist a member with providing detailed information on their plan benefits, including limitations and exclusions
What is Verification of Benefits (VOB) Medicare Overview?
I am the two allowance options when it comes to spending cards
What is Over the counter and Healthy Options?
These two tools are used to locate providers.
What is
Find Care
Provider at a Glance (PAAG)
Timeframe for Urgent/Expedited Authorization Requests
What is 72 Hours?
A limit or cap on the amount member pays for their covered medical cost within a plan year. once this met, a member will pay $0 for the remaining medical services
What is Maximum Out of Pocket?
We use this classification and intent if a member calls in to get information about their healthcare benefits
What is Classification: Benefits, Intent: Verification?
True or False
A member can qualify for the Healthy Options benefits if they have a chronic condition medical claim on file with Humana as of January 2019.
What is False?
This is a server-side tool used to find more information about that provider’s credentials, demographics, or contract.
What is
PAAG
Mentor document you have to access to determine whether a service requires prior auth and identify the responsible managing entity.
What is Humana Customer Care Preauthorization and Notification List?
This means that the providers participate in the member network and accept agreed upon contract rate. reffered to as "par"
What is In-Network?
This information is only an estimation of benefits. All payments are based on Medicare policy guidelines, medical necessity, and member eligibility at the time of service. What am I?
What is the VOB Disclaimer?
True or False
Allowances rolls over at the end of the plan year.
What is False?