ADVOCATE BASICS
This is the primary goal of every Medicare Advocate.
What is providing excellent member service?
This system is used to document member interactions.
What is CRM Service?
This protects member information and is required on every call.
What is HIPAA compliance?
Members often request this when they lose their original.
What is an ID card?
A member's primary healthcare provider.
What is a PCP?
These are the two main types of Medicare coverage options members may have.
What are Original Medicare and Medicare Advantage?
This tool helps advocates quickly locate information and resources, it should be used at the beginning of each call
What is Quick Start+?
Permission from the member to discuss information with another individual.
What is consent?
This process confirms a member's enrollment and benefits.
What is eligibility verification?
A PCP assigned automatically when a member does not choose one.
What is an auto-assigned PCP?
This resource should be used on every call and contains policy information, procedures, and job aids.
What is mentor?
This toolbar contains quick access to advocate applications.
What is the DIG Toolbar?
Someone attempting to gain unauthorized access to member information.
What is a bad actor?
THE AMOUNT MEMBER PAYS MONTHLY FOR THEIR HUMANA INURANCE
WHAT IS A PREMIUM?
These providers have contracts with Humana plans.
What are participating providers?
This principle focuses on resolving a member's issue during the first interaction.
What is First Call Resolution?
This application displays member information and plan details. It is only used when CRM gives an error or does not contain information requested.
What is Customer Interface?
THIS IS THE MENTOR DOCUMENT USED FOR AUTHENTICATION PURPOSES
WHAT IS HIPPA OVERVIEW?
This penalty may apply if a member delays Medicare PART D enrollment, it is a lifetime fee
What is an LEP?
Physical, occupational, and speech services fall into this category.
What are therapy and rehabilitation services?
The experience a member has throughout their interaction with Humana.
What is the Member Experience?
This system is used to answer and manage calls.
What is Softphone?
THIS IS NEEDED TO FULLY AUTHENTICATE A CALLER
WHAT IS H# OR MEDICARE ID, DOB, AND ZIP?
This process ensures member payments and balances are accurate.
What is account reconciliation?
This assessment helps identify member health needs and risks.
What is an HRA?