Benefits
What are the 4 steps of the VOB cycle?
Verify the provider, quote the benefit, check accumulators, check if an authorization or referral is needed.
Name all the ways a member can submit their disenrollment request.
Written request, online form, physical form.
What's the screen on CI to verify LIS benefits?
CLIS
What is the criteria to qualify for a grace period?
Be agent assisted, have been enrolled in the last 4 days of the month, calling before the call-by date.
Cual es el segundo nombre de Sofi?
Isabel.
What are the authorization and referral review timeframes?
Non-urgent/non-expedited: 14 calendar days
Expedited: 72 hours
Name two examples of an involuntary disenrollment.
Loss of Entitlement, Unlawfully Present, Delinquent in Payments, SNP not validated, Loss of Medicaid Eligibility, etc etc
Name the two programs members can apply for to help reduce the price of a Medication.
LIS and MPPP.
In which CI screen can we find the verification control ID?
PCRP.
Como se llama la mascota de Budde?
Hunter
How is the Healthy Options Allowance eligibility determined?
By having a qualifying diagnosis of a chronic condition or by having a chronic condition claim on file with Humana as of January 1, 2021.
Name all of the enrollment periods.
Pre-enrollment, Initial Enrollment Period IEP, Annual Enrollment Period AEP, Special Election Period SEP, Open Enrollment Period OEP.
What are the types of overrides we handle?
COB and mail order delay.
Name all of the CI screens used when processing a cancellation of enrollment in order.
PAPI, PAIG, PATR, PACT, CITR, and PCCV
Name 3 Operation Managers.
Gerson Moncada, Hugo Flores, Francia Flores, Elena Fortin, Aimee Rodriguez, Kristofer Velasquez
Member is calling to verify coverage for Vitamin B-12 injections. How would you quote the benefit?
Part B drugs + Surgery Services
How can I determine if a member has been auto-assigned into a PDP?
The Hum Enrol Src code in PAIG will display the letter C, A, R, or H.
Where in RxNova can we find the manufacturer of a medication?
"Drug Information" tab in a claim.
How can we identify a Mass Move?
CRM termination date on one plan and effective date for future plan.
Check the ERC on PAPI screen
Check MACH screen on CI
Checking The Beast
Who funded ResultsCx?
David De Luna