KYMCD THE BEGINNING

HIPPA

100

PHI

any information in a medical record that can be used to identify an individual, and that was created, used, or disclosed while providing a healthcare service, such as a diagnosis or treatment.

200

MEMBER AUTHENICATION

• • Member name
• • Member Identification (ID)
• • Member Date of Birth (date of birth)

300

CHECK INFORMATION NOT AUTHENICATED

Only the check amount and if the check has been cashed or is outstanding can be given over the phone. Can also offer to send EOR to address or fax number on file for the provider or facility.

400

MEMBER NAME

MUST MATCH EXACTLY INCUDING HYPENATED NAMES

• DO: Ask probing questions such as "is it possible that a nickname is being used instead of the legal name?"
• .
• DON'T: Give any information about what Humana has in the system.

500

CLAIM STATUS OTHER INFORMATION

Can't be Disclosed: Details on any other provider's claims or services not rendered by the provider or facility calling.

•  All claim details except diagnosis and procedure codes. You can't offer the information, but if the provider asks, then you can release the information.
• - Another provider's name and DOS can be given only if it affects the calling provider's claim.

MENTOR

100

GO LINKS

GO/MENTOR 

GO/LMS

GO/HI

GO/WORKDAY

I have found a list!! It will be sent out via email

200

FUNCTION AND SUBFUNCTION

Function: Contact Center Provider 

SubFunction:  Medicaid 

300

MENTOR TIME

TIME TO REVIEW EMAILS, HOT TOPICS, UPDATES TO DOCUMENTS, ANY SHORT TRAININGS 

400

DAILY DOCUMENT 

HIPPA

DOCUMENT INDEX

500

TYPES OF MENTOR DOCS

OVERVIEW

EXCEL

STEP ACTION = IF THEN THEN THIS

STEP ACTION WITH SCENARIOS = IF THIS THEN THIS WITH EXAMPLE

Document Index

100

COB

OTHER INSURANCE THE MEMBER MY HAVE

MEDICAID WILL ALWAYS PAY LAST 

200

CLAIM IMAGES

HUMANA IMAGE VIEWER

EHUB

300

CLAIMS ADDRESS 

Address, Fax, and Telephone Numbers

PO BOX 14601 

LEXINGTON, KY 40512-4601

400

Cold vs Warm

Cold transfer= when you transfer to another department without introduction

Warm transfer = introduce the caller 

500

Emergency

Call Termination During a Building or Site Emergency CCC Provider

Basics

100

HUMANA MEDCAID STATES

FL     IL     IN

KY     LA     OH

OK     SC     VA

200

DUAL ELIGIBLE

MEMBER HAS BOTH MEDICARE AND MEDICAID (ALSO REFERRED TO DNSP)

300

ELIGIBILITY FOR MEDICAID

STATE DETERMINES WHO IS ELIGABLE AND WILL VARY FROM STATE TO STATE

Children, Pregnant women, Parents, Seniors

Individuals with disabilities

400

MEDICARE

FEDERALLY FUNDED AND IS DETERMINED BY AGE

500

COVERAGE

INPATIENT

OUTPATIENT-PCP, DME (DURABLE MEDICAL EQUIPMENT, TESTING, SPECIALITY VISITS

PRESCRIPTION DRUG PLAN

Humana

100

ANTHEM

OUR INSURANCE CARRIER

200

WORKDAY

WHERE WE SUBMIT OUR TIME DAILY, VIEW PAYSTUB, MAKE CHANGES TO PAYROLL, 

300

BIOMETRIC SCREENING

MUST BE COMPLETED BEFORE 11/20/24 TO AVOID THE SURCHARGE  

400

VIRGIN PULSE

OUR WELL-BEING REWARDS APP,  IF YOU HAVE A SMART WATCH YOU CAN TRACK YOUR FITNESS

GO/WOW 

500

NRG

Each NRG offers associates the opportunity to network, grow as professionals and share their thoughts and ideas to expand opportunities in the workforce. Members receive opportunities to contribute to making innovative, smart business decisions that benefit our ever-changing, diverse members.