Systems/Applications
Where do we enter our time sheets?
Workday
How many Client Options do we have for CAS?
Three
CAS Client 56 - TX & AZ markets
CAS Client 57- FL & GA markets
CAS Client 58- ALL other markets
Where is CI found?
HODMOD
Does EVERY time someone other than the member calls require Verbal Consent, Consent Form, or POA?
No
Which two systems do we use for reviewing claims?
CRM & CAS
What two applications are found within HODMOD?
CAS & CI
What is a CAS Control Line?
The Line we type into CAS to generate information needed
Once logged into HODMOD and your session has been selected which option number do you pick to get into CI?
2. Customer Interface
What is the Mentor Document that can help us in ensuring we get enough information to assist a caller that does not have consent of any sort?
HIPAA Job Aid Member or Individuals
What are the claim statuses?
Pended, Paid, Partially Denied, & Denied
What app must be opened for our calls to come through?
Genesys Cloud
What Mentor homes our CAS Control Lines Quick Reference?
Control Lines Quick Reference
Which CI Screen should be your starting point?
PAPI
A member needs their Humana ID Number. Can we provide that to them?
No
Which CAS Control Line do you enter when you want to look at a particular claim in CAS?
MHI
What is Humana Image View Station used for?
Generating/Viewing paper claims & paper correspondence.
What does the MDI Line display?
Displays claims in the requested month and year for a member.
Which CI Screen has POAs listed?
PAIG
Members daughter is calling in due to mother being in the hospital. She authenticated herself through the IVR. She wants to know if the authorization for the stay has been approved. What information does she need to get Auth status?
Date range
Rendering physician or hospital
Service provided
Which CAS Control Line do you enter when you are searching for a claim not found in CRM?
MDI
What is MARx used for?
CMS System where we can check member eligibility, hospice dates, LIS status, etc
What does the PRI Screen Display?
Displays the hospital admission approval/denial.
Which CI Screen is for Demographic Changes?
PEDM
Member has passed away. Cousin says he is EOE but, nothing is on file. He has a concern about a denied claim. Can we help him?
Yes IF he has
DOS, Providers Name, Claim Number, & one of the following...
When you have a Partially Denied claim, how do you explain the status?
When quoting claim status, do not state "Partially Denied". It must be stated as "Paid with Adjustments".