System/Mentor Basics
What system do we log into FIRST each and every day?
Genesys
Can just anyone join Group Medicare?
No, it must be a retiree or eligible dependent in which their retirement has a plan administered through Humana
Which mentor houses the call flow?
Custom Connect Group Medicare Call Handling
What application within CRM do we use to notate?
Quick Start aka QS+
What does Medicare Part A cover?
1 - Medicare Part A – Hospital Insurance
This covers things like:
• Inpatient hospital stays
• Skilled nursing facility care
• Hospice care
• Some home health care
Where do we communicate daily?
Teams
What is the CMS Star Rating Program?
The Centers for Medicare & Medicaid Services (CMS) Star Ratings system is intended to help Medicare consumers compare the quality of Medicare health and drug plans being offered alongside information about benefits and costs.
How many steps are in the call flow?
13 Steps
What Mentor shows us approved abbreviations?
Internal Documentation Standard Abbreviations
What does Medicare Part B cover?
Medicare Part B – Medical Insurance
This helps cover:
• Doctor visits
• Outpatient care
• Preventive services (like screenings and shots)
• Durable medical equipment (like walkers or wheelchairs)
Which Mentor is our starting point?
Group Medicare Calls Document Index
Where do we go to find out specifics about a members group?
GO/GMAIRC
What is our required Opening?
"Thank you for calling Humana. My name is (name), your healthcare advocate, how may I help you?."
What does MGMN stand for?
Medicare Guidelines, Medical Necessity
What does Medicare Part C cover?
This is an all-in-one alternative to Original Medicare (Parts A & B) offered by private insurance companies approved by Medicare aka Humana in this case.
It includes everything in Part A and Part B, and most plans also offer extra benefits
Where do we go for applications?
go/myapps
What are the three plan types Groups can offer?
MA (Medical Only)
MAPD (Medical w/Prescription)
PDP (Rx Only)
What is our required closing?
"Thank you for calling Humana, we are always here to help."
Member calls in and asks for their PCP Copay, do we document?
No
What does Medicare Part D cover?
This helps pay for prescription medications and is offered through private plans.
What application is the home of CAS/CI (Customer Interface)?
HODMOD
What are the three Group Medicare Product types?
MGP (PPO)
MGR (HMO)
MPD (PDP)
If a member has another question after asking issue resolution, what step do we have to follow back to?
Follow back around to Step 2 and repeat call flow process (ONLY if they have a new question) per Step 9
We have to make an OBC to a provider, what details need to be documented?
Name of provider you called, their phone #, whom you spoke with, what they advised you
What is the advantage of a Part C plan?
• Combines coverage into one plan
• May offer lower out-of-pocket costs
• Includes extra services not covered by Original Medicare
• Often includes drug coverage (Part D) - These are called MAPD Plans