Phones
you get a call and say
what is "Thank you for calling Humana's Home Solutions UM Team, my name is [Name & Title]. This call may be recorded for quality and training purposes. How may I help you?"
For denials member's with an HMO plan i send a Letter to?
what is Member PCP ordering and HHA unless pcp and ordering are same
i offer P2P to which provider
what is Requesting Provider
what should i do if an Auth comes in with 5 visits for G0299 SOC?
Auto Approve Request
request received for 11 G0299 as a SOC what should i do with the request?
Pend to Clinician
Member rep calls to get status of auth what do you need
what is POA or AOR
True or False should i be checking my Fax Status every hour?
What is True
i have a Medical Assistant Accepting to do a p2p to do themselves
What is MD, PA , NP
for Centerwell what document must we enter each case in?
What is Business Rule Exception
Authentication consist of which elements
what is Member ID, date of Birth and Provider NPi or Tax ID
you get a call and authenticate; you have member pulled up and provider states i want to verify member benefits. do you document?
what is member level notes
Do i need to send the UMAC 3s a Spanish Approval Letter for translation?
What is No
p2p offer fails by Fax and Phone and unable to reach HHA
what is No P2P/ HH Agency on Denial Template
if i have an auth that overlaps with no hospital stay in between i must call the (Blank)
what is Home Health agency
i have a conviva member in market guide i follow what direction?
what is do not build also means do not add
call comes in and i go into aftercall how long am i allowed to stay in
what is 2 min
if a case is manually pended and stayed overnight in pending status do we need an Approval Letter?
What is Yes we need to send an Approval Letter
provider wants to accept P2P after determination made
What is Appeals Department
can a 485 be found for centerwell if so where?
what is yes under orders
what is on authorized units when adding 5 visits to an approved with 10 visits prior?
what is 10 visits
HHA calls in to request Expedite
what is unable to request and will follow Standard process
Day's aging 12 must be sent through (BLANK)
what is Veritas
i have a WA member that i am offering P2P for it is now a day 12 at 2 pm i offer p2p for 10 AM PST to call back, what goes into the next review comments
what is CB by 1 PM EST
True or False: I have an Elara case and i must send to the clinicians I send the case to the HSUM Legacy Clinician queue.
what is False
Conviva Grouper ID 84301402 which Conviva queue do we send this auth to?
What is none send to the HSUM Legacy Clinician Queue