Billing
this link is where we would go to assist member with billing issues
EBilling
what class/intent do we use for benefits
benefits/verification
Who is the Class/Intent when making a change
Demographics/ Change
what class/intent do we use for pcp changes
pcp/change
what class/intent do we use when finding providers?
provider/locate
Do all members have a humana premium
No, they do not. some members have a 0 premium
can we give benefit info to a members rep without consent?
yes, we can provide general info without having consent
what mentor doc do we use for demo changes
Demographic Changes for Medicare Overview
what document do we use when making a pcp change
Primary Care Physician Changes for Medicare Overview
how many different search categories are there to locate a provider
there are 7
all, name, specialty, condition, phone number, NPI number, state license number
If a member receives a pas due balance letter. what 2 places would we search for it?
RTI and EMME
What are the 3 places we can search to quote benefits
debut, benefit grid, EOC
300 extra points if you get them all
Who can make a demo change
member, poa, agent
Who can make a pcp change?
member, certain poa , provider with member on the line
what system do we use to locate physicians?
find a doctor/ physician finder
What are the 3 ways a member can pay their Humana premium?
credit card, SSA, bank withdrawal
what would we quote if a member wants the copay for an injection?
we would quote surgery copay as well as part b medicine copay
what website do we use to verify members name, birthday, gender
Litton
what is the standard eff date for pcp changes
The 1st of the following month
if you are unable to locate a dr in pfp but member says they should be inn. what system do we use to verify?
PAAG
What is the form members have to fill out in order to avoid the Late enrollment penalty?
bonus 100 points for the 2 ways member can complete form
Creditable coverage form.
to be proactive. what other info should we offer when quoting benefits?
also want to offer to locate provider and if the member will need a ref/auth
what screen in CI do we use to make manual changes
PEDM
what screen in CI do we use to make manual pcp changes
PAMG screen
what system do we use to find a psychiatrist or dentist
trick question! we transfer those calls to behavioral health and dental depts
200 extra points if correct