Wave 1

PCP

100

What are the 2 systems we use to locate a provider?

PAAG and PFP

200

What is the main system we use to locate a provider?

PFP

300

Who can request a PCP Change?

Members or Member Representatives, Agent, and Provider (with members consent)

400

What do you file when a member is calling in complaining about the doctor's office being rude and not listening to their concerns?

QAA

500

How long does the member have to select a new PCP when the provider contract terminates with Humana?

30 Days

Demographics

100

How often does demographics need to be verified? 

Every 90 days.

200

True or False: Does a name change require CMS corroboration?

True

300

If a member is a snowbird and lives in Minnesota and goes to Florida for the summer, do they need to update their mailing or residential address with Humana?

Mailing address so they can get their mail.

400

Does Humana update the Date of Death (DOD)?

A member's DOD is the only type of demographic change Humana does NOT update.

500

What is one thing that we never ask the member for?

SSN

C/I

100

What would be your classification and intent for a PCP Change?

Classification: PCP Change 

Intent: PCP Change made

200

What would your classification and intent be for a demographics change?

Classification: Demographic

Intent:Change

300

What would your classification and Intent be for a member calling in to locate a provider?

Classification: Provider

Intent: Locate

400

What would your classification and Intent be if you were unable to change a PCP for a member?

Classification: PCP Change 

Intent: PCP not changed

500

What would your classification and Intent be if a member was calling in for a password reset for MyHumana?

Classification: Web and Mobile 

Intent: User id/password

Billing

100

What are the 4 Premium Payment Methods?

Credit/Debit

Coupon Book

Automated Clearing House (ACH)

SSA/RRB Deduction

200

How long can it take to switch to SSA Deduction from a CC?

Up to 120 days

300

When does Humana issue bills for the premium payment?

20th of each month

400

What 2 payment options can the member make a one-time payment with?

One-time payments are accepted by phone using a credit card or ACH option.

500

What are 2 reasons premium payments cannot be accepted?

Premium payments cannot be accepted over the phone if the following apply:

• The member is termed
• The member has a $0.00 balance or credit on their account

Web and Mobile

100

What can members do on Humana.com when they sign in?

• View plan coverage details.
• Access Humana ID cards and personal health records.
• Share coverage details and ID cards with their doctor.
• Check claims status and history.
• Find in-network providers near them.
• Chat with a customer service agent.

 

200

Can we set up members MyHumana Account?

No

300

Why do we have the 2-factor authentication?

extra layer of security by protecting the member's personal information and privacy

400

What do we use DAM (Digital Access Manager) for?

• Assist with password resets.
• Reset Multi-factor authentication (MFA).
• Assist with web issues.

500

What mentor do we use for when members are locked out of their account?

Humana.com Account Lockouts