Easy
It is a fixed amount that member pays to the provider
What is a Copay?
It is a monthly payment to the insurance
What is Premium?
Team that handles all precertification, case management and claims repricing for behavioral health.
What is Behavioral Health?
Are you the right person to answer questions about Humana health benefits?
What is a CMS test call?
YES
A percentage amount that members pay to the providers.
What is Coinsurance?
Tool to locate providers
What is Provider Locate?
Benefit where members earn rewards through completing activities that help them reach their health goals.
What is Go365?
Total amount that member pays Out of Pocket for medication
What is TrOOP?
Attributes that identify a member's identity
It is known as Donut hole
What is Coverage gap?
If address has not been validated within the last 90 days.
What is Verify Demographics?
If member expresses dissatisfaction or complaint during the call.
What is Grievance?
A document where all medications covered are listed
What is Formulary Drug List?
It is needed to have an appointment with a specialist doctor with a HMO plan
What is a referral?
A Prosthetic is considered ......
What is DME?
Panel to see latest communications sent to member
What is RTI?
IVR system to process payment
What is Secure Pay?
County-based Plan
What is MAPD?
Deductible, Initial Coverage, Coverage Gap & Catastrophic.
What are Benefits Stages for prescriptions?
Tool to quote benefits
What is debut?
An unique ID and 3 extra items are needed.
What is the authentication process?
What is HCPR?
What is the medication that always will have a $35 dollars copay for 30 days supply?
What is insulin?
Statewide Plan
What is PDP?
Explain the coverage gap
What is the coverage gap?