PFP/PAAG/PCP CHANGE
When sending member a provider listing from PFP, what email address can members expect the email to come from?
donotreply@humana.com
What page would you view on a member’s account when you are confirming demographics?
Person Account Page
Who can verify/update demographics?
Member, legal guardian, POA
After a member becomes active in CI, how long until the member shows active in CRM?
48–72 hours
What is the turnaround time for ordering ID cards?
5-7 Days
True or False: A doctor can practice at several locations and ALL of them are INN with Humana.
False. A doctor can practice at several locations with some being INN and others being OON with Humana.
When wanting to view details of member’s coverage, what page do you navigate to in CRM?
Policy Member Page (Umbrella Page)
If members do not report their new address to the state, how long before the member’s plan is changed, or they are disenrolled by the state?
30 Days
True or False: We see a members state Eligibility.
False
What events cause an ID card to generate for members?
Any changes to UMID, member name, group number, DOB, or PCP
How many providers can you compare at one time using the Compare button?
3
If a member says they received a letter or call from Humana, where can you view it in CRM?
Communication panel on the right-hand side of CRM
In what circumstance can a residential address be Post Office box?
If the member is homeless or in a shelter, they can use a P.O. box as their residence.
What screen in CI can you see when we received a members application?
PAPI
If a member’s card displays ‘Medicaid Secondary’ instead of a PCP, what does this mean?
They have a primary carrier.
If a member requests to have the provider listing from PFP emailed to them, what Mentor document would you use to help?
Send Provider Search Results
When creating cases from QuickStart what page in CRM do you need to be on?
Policy Member page (Umbrella Page)
If a member is JUST changing a phone number, do they still have to contact the state agency?
Yes, to ensure it is a permanent change it must be reported to the state.
If there is an instance when a member shows MULTIPLE active Medicaid policies, what should you advise the member?
Advise the member they must contact the state they do NOT reside in to terminate the inappropriate coverage.
What screen in CI can you send ID cards from?
PAID
What mentor would we use if we have to do a manual PCP change in CI?
Primary Care Physician Change in CI Medicaid and MMP
Where can you find the Medicaid ID in CRM?
Policy Member page under Member IDs at the bottom
What screen in CI is used to create a task if we have to update the demographic change manually?
PATR
What mentor document would be used for Eligibility Verification? (State Specific)
Eligibility Verification and Access to Care for Oklahoma Medicaid
In CI what button do you hit to request the ID card?
F2