Humana Systems
What is the main system used to handle and document calls?
CRM
What does the acronym HIPAA stand for?
Health Insurance Portability and Accountability Act (HIPAA)
What classification would you use for a provider calling in to see if a members deductible has been met?
C: Benefits
I: Accums
How many Step are there in the call flow?
Which animal has the highest blood pressure?
Giraffes
What are the two systems that we use to look to see if providers are in network?
PFP (Find a doctor) and PAAG
True or False: You do not need to authenticate the caller if you are just giving benefit information.
False
What Classification and Intent is used when provider is calling to see if an Authorization is needed for a procedure?
C: Auth/Referral
I: Requirements
What is the first thing you should fill out in QuickStart after the callback number?
Classification and Intent
What is a male swan called?
Cob
What system do we use to locate letters that was sent to providers?
EMME
What information is needed to authenticate the caller that is calling on behalf of the provider?
•First name & call back phone number (not HIPAA related)
•Tax Identification Number or NPI
•Provider/Facility Name
What classification and intent is used when a provider is calling about a denied claim?
C: Claim Status
I: Denied Claim
What does IPA stand for?
Independent Practice Associations
What are the only birds that can fly backward?
Hummingbirds
What system other than CRM do we use to view claims?
CAS
What information do you need to Authenticate the member the caller is calling about?
•Member’s Name, Member ID, and Member’s Date of Birth.
If any of those pieces are unknown or incorrect, you can alternately verify one of the following:
•Member’s ZIP code, group name, group number, or product type.
If a provider is calling checking the status of an appeal what classification and intent would we use?
C: G&A
I: Status
What does COB stand for?
Coordination of Benefits
What is the only big cat that lives in groups?
Lions
What is the main system that we use to launch systems and automate processes?
Hint: Not Launchpad
DIGBOT
What is the mentor that you would use for all HIPAA related questions?
HIPAA Overview CCC Provider
If a provider is calling because they have moved to a different address and need to update that with us what is the classification and intent you would use?
C: Provider
I: Demographics
What mentor document do we use that house all of the main mentors?
Document Index CCC Provider
How many toes does a guinea pig have?
14 toes total, 4 toes on their front feet and 3 toes on their back feet