Week 2 and 3 Summary

CI-Screens

100

What is the CI screen you can use to send out ID-Cards?

PAID Screen

200

What Screen in CI can you change member's demographics?

PEDM Screen

300

What screen in CI do you go to look up member's by name/DOB or SSN?

PESL Screen

400

What screen do you use to change a member's PCP?

PAMG Screen

500

What screen do you need to go to create a task in CI?

PATR Screen

Demographic/PCP Changes

100

What are the steps to update demographics in CRM?

Refer to mentor, Create a case associate to policy and then use the Demographics template located in the processes field. 

200

What is considered a critical demographic?

Name: First, Middle, Last, and Suffix
Gender
Date of Birth(DOB)
Date of Death (DOD)
SSN

300

What can we not list as a residential address when updating demographics?

P.O. Box Adress

400

Demographics can only be verified by who?

• Member
• Legal guardian (when the member is under 18)
• Power of Attorney (POA) type H, C, or O

500

How often do we verify Demographics?

Every 90 Days

Systems

100

What two systems/ tools do we use to verify if a provider is in network?

Find Care and Provider at a Glance (PAAG)

200

What is Digbot used for?

To quick-automatically sign into all of the systems you may need throughout the day.


FE: CI, CRM, Email, Mentor, OTC Order...etc.

300

What is the phone system we will use every day in production?

Genesys

400

What is the main system we will use for call guidance or call related questions?

Mentor

500

What is Solutran/ nations benefits used for?

Check on member's Spending Account Cards, Transaction history, Balances.. etc.

Special handeling

100

What are three verbiages to tell if it is a CMS test Caller on the line?

Hint: CMS Test Calls

• "Are you the right person to answer questions about Humana health benefits?"
• "Are you the right person to answer questions about Humana prescription drug benefits?"
• "Are you the right person to answer questions about Humana Gold Plus Integrated Medicare-Medicaid Plan's health benefits?"

200

What is the HEAR Acronym? What Mentor Document is it in? 

• H = Hear the inquirer:
• E = Empathize:
• A = Apologize:
• R = Resolve the issue

Escalated Call or Chat Overview

300

Who can members contact for Behavioral Health if they are needing to talk?

• Members or someone they know can call, text, or chat 988 for behavioral health or substance abuse help for themselves or someone they know.

400

When you have a foreign Language call on the line you will have to use a few mentor documents like this one: Interpretation Services Translation Assistance and Leader Escalation Procedures that can be found in Mentor: Incoming Foreign Language Calls

By using these documents, what are the Voiance Pin Numbers for your 3 required states? 

IL: 1617
MI: 1665
SC: 1631

Voiance Translation Services PIN Numbers

500

What is the Classification and Intent for a Misrouted call?

For, Misrouted Calls: True Misroutes 

Classification: Misrouted Call
Intent: Transferred to Correct Skill

Mentor

100

What is the MAIN mentor Document you use for member's who request to be put on the DNC list?

Do Not Call/ Remove from mailing List requests.

200

What is the Mentor document you can use for all phone numbers you may need?

Phone Number Overview Medicaid.

300

What is the Mentor Document you would use when you have a member who speaks a language other than English?

Foreign Language Call Overview

400

What is the Mentor document we should use when member's have questions about their Smart Summary?

Medicare SmartSummary Statement Overview.

500

What is the Mentor Document you would use if member calls in about their Spending Account Card?

• Humana Spending Account Card Overview