Communication Methods
Humana corresponds with members through various letters and forms generated by this fulfillment system
What is Enterprise Measurable Messaging Ecosystem (EMME)?
A tool that allows you to view an electronic copy of a member’s ID card (front and back). This tool allows you to view current ID cards for any plans a member has, and letters of coverage for those requesting proof of coverage.
What is the ID Card Center?
This app is a way our members can manage their health online providing more autonomous access.
What is MyChart?
You can view EMME through this section in CRM
What is the Real Time Interaction (RTI) Communications section?
A member calling in for any of the following:
Plan information: new or replacement copies of the Summary of Benefits or Evidence of Coverage detailing the benefits available.
Proof of Coverage letter: written verification typically requested by new members waiting for receipt of their Humana ID card.
Over the Counter (OTC) Nutritional Supplement form: requested to place orders for wellness products.
Full provider directory containing a list of in-network providers members can choose from for their healthcare needs.
Full Prescription Drug Guide showing all medications covered under Humana's drug list.
Member Handbook (Medicaid): Detailing the benefits available for Medicaid only plans.
What is a fulfillment request?
Members can use this app to order, request, refill prescriptions and check an order status.
What is CenterWell Pharmacy?
In regards to PCP and BH provider terminations this is when customers receive a notification letter
What is 45 days before termination effective date?
When it comes to documentation, eligibility related calls are captured under the following case options:
What is Eligibility and Verification?
This allows you to see what the member sees and provide better guidance in answering the member’s questions. It will only work for members who have an activated MyHumana account. It does NOT work for a pre-effective onboarded member.
What is the Web Emulation Tool?
This is essentially a comprehensive overview of the member's health benefits and claim activity for the previous month.
What is SmartSummary?
This plan covers eligible individuals who have both Medicare and Medicaid.
What is a Dual Eligible Special Needs Plan (D-SNP)?
Members with this benefit earn rewards through completing eligible fun and engaging activities that help them reach their health goals.
what is the Go365 app?
This team is in charge of updating and correcting other insurance benefits (OI), responding to the member about updates and investigations for other insurance (OI) and making sure that benefits run smoothly and efficiently.
What is the Coordination of Benefits team?
This page provides the following plan information to assist the member:
Member’s identification (ID) number
Product Type - Product Type Code
Status
Effective - End Date
What is the Plan Member page in CRM?
When speaking with a member, educate them about the information they can access on this system.
What is MyHumana?