Wave 1
Which tool is used to log into all of your applications at the start of your shift?
DIG toolbar
What is the ONLY Humana Medicare Plan that may require a referral?
HMO
Where is CRM can you update the members preferences?
Policy member and persons account page
A medical authorization pending status for a non-urgent /non expedited appeal should not exceed this time frame?
14 days from the date of request
How do you tell if a member is going to leave a VOC (survey)?
You can't so you treat every case as if they are going to
When required, whose responsibility is it to ensure an authorization or referral is on file?
Member
Where can you view a members Smart Summary?
CRM
What resource do you use when determining whether an authorization is required for a service?
Pre-Authorization and Notification List (PAL)
Which step can occur multiple times through out a conversation to show a caller you care?
Empathy
What makes an item a DME?
Reusable
When handling a QQA complaint, where is the case routed to?
OGO Oral Grievance Oversight Team
How do you handle a call regarding Gastric Bypass surgery for weight loss?
Dedicated associate for bariatric calls
What is a LEP?
Premium penalty for not having part D coverage for 63 days or more
What benefit do you quote the member for bone density scan?
Bone Mass Measurement
Humana bills member around the 20th of each month, when is the payment due?
the 1st of the next month
In debut, how would you quote an MRI?
Outpatient Advanced Imaging Services
How long is a member responsible for an LEP?
As long as they have rx plan or they qualify for LIS
If a member is not satisfied with the denial of their medical authorization, what option (if any) do they have?
Request an Appeal
What is the EMME letter code for the Medicare Consent for Release letter? (PHI)
ME2427
Name the four Ancillary providers. (PARE)
Pathologist Anesthesiologist Radiologist and ER Physician