Eligibility
Communication
Provider Locate
Demographics
PCP Change
100

Relate to the customer and their emotions

Reassure, and relieve frustration or discomfort.

All these falls under what category of customer service

Empathy

100

Where to go if you needed to handle an automated call and the information is not in the Communication panel of CRM?

  1. EMME
100

I need to know if my provider is inn with my plan, where can i verify this information. 

Physician Finder

100

Name two reasons a member may need to change their demographics

Member is moving

Member has new Medicare ID

Incorrect Spelling

Email Address Hacked

Gender Marker Change

Marriage/name Change


100

What does PCP means?

Primary Care Physician

200

I am required on all calls to alert my fellow coworker.

  • Document
200

What other system can be used to check for Commumication sent?

EMME

200

What is a provider that has a contract with the insurance company called?

Participating (Par)/ In Network (INN

200

Why would a member choose to change their PCP

Not satisfied with care from their current doctor

Office location may be too far away.

New preferred doctor joins the area.

300

Approach me as person

Meet me where i am 

Anticipate my needs

Don't make me repeat myself

What part of the perfect experience requirement am i.

.  KNOW ME

300

Where can you view recent letters or automated calls?

Communication Panel in CRM 

300

I am an oncologist, what an i referred to as in Physician Finder

Specialist

300
  1. How can Humana assist members with plans requiring a PCP??

Verify if PCP is inn

Confirm if the PCP is accepting new patient.

Honor change request from authorized callers

Process the change in Humana system.

400

What are the first 4 steps of the call flow

1.Greet

2Show Empathy

3.Understand the Issue

4.Resolve the Issue

400

What are some reasons a member might received an automated call?

  1. Medication refill reminders.
  2. Providing automatic payment options.
  3. Inform of any gaps in care.
  4. Reminder to get flu shot.
400

I am a secondary system used to locate providers information.

PAAG

400

Who are the persons that can update demographics? 

Member

POA or EOC

Agent

400

Who can request PCP change?

Member or POA

500

What is the name of the Mentor document that guides you as to what information you can provide to a caller.

  •  Hipaa Overview
500

What is the C/I for A member receiving a letter?

C: Communication

I: Got a letter/call

500

What does the heart and badges below the doctor's name mean? 

Hearts represent Clinical Quality

Badges represent cost-efficiency ratings.

500

What do you need to do if a member demographic update shows them OSA?

Advised of the timeframe that their plan will remain active and also, they will need to speak with sales to get a new plan for the area they will be in.

500

What is the mentor document used for PCP Changes?

Primary Care Physician Change for Medicare Overview

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