Web/Mobile
If the member forgets their username, what should they do?
Click forgot username
True or False: We should always close the case when dealing with COB calls.
False
What happens to HMO members who don't assign a PCP?
Humana auto assigns a PCP
What is the name of the vendor that helps Humana with preauthorizations?
Cohere
True or False: We can help quote Dental benefits
False, we transfer to the Dental team
What do we click in DAM to reset multi-factor authentication for members
Reset MFA
What is the C&I for member who want update OI status.
COB/MEDICAL UPDATE/DISPUTE
True or False: PPO members can have multiple PCP on file
False
How long is an expedited preautorization request?
24 to 72 hours
True or false: We help providers with benefit questions
False, we transfer to the provider queue
What is the process used to assist with web browser navigation questions
Web emulation
Who decides which insurance is primary or secondary?
Medicare (CMS)
When are pcp changes effective from
1st of the following month
How long is standard preauthorization request
7 to 14 days
What is the main tool we use to quote benefits
Debut
What is the name of the system we use to reset member's passwords?
DAM
How long does an OI investigation case takes to be resolved
30 Calendar days
What is the difference between PCP changes for PPO and HMO
For HMO members the card reflects the PCP name and PPO doesn't.
PPO can choose not to assign a PCP while HMO are required to assign one.
What is Transition of Care?
Type of authorization that allows new member to continue seeing an OON provider at an INN level for 90 days
What is the C&I for these calls?
Benefit/verification
Before assisting members with online accounts - What's the first thing we need to do?
Check if the member's account activated.
What is the name of the team that handles COB cases.
OI investigation team
Which POA can make changes to the member's PCP
POA H & C
What is Continuity Of Care?
A type of authorization that allows existing members to see an OON provider for 90 days.
What is the process of quoting benefits, checking authorizations and provider locate on one call, called?
Triangle of care