Mentor
This is our home base for regular Medicaid calls non pharmacy related
Medicaid Calls Document Index
This is my main system to take calls in
CRM
Used any time a case is created but the requestor is not authorized to receive the information they are requesting
Hippa/ Not Authorized
How many days can a member expect to receive their Humana ID once you place an order
5-7 days
What is the expanded vision benefit
Use the document to update a member's address
Address Change Calls Medicaid
Member is having eligibility issues, we have checked CRM and CI, what other system should I check
MEVS
Used when the demographic info is confirmed and not updated (Including address, phone, email, name, date of birth, gender & Medicare ID)
Examples:
Is my phone number correct I never receive calls anymore from Humana.
I want to see what email you have on file for me.
Demographic/No Change
How many days once the member is approved by the State for Medicaid can we expect to receive the file and member information loaded into CI
around 72 hours
Member has an accidental injury to their tooth, what benefit are you quoting
Dental Services - Emergency
Services to restore a natural tooth, as best as possible, due to accidental injury
Base Services
Services in a hospital or surgery center
This document is used to locate the information needed for non-English speaking members to handle your call
Incoming Foreign Language Calls
Member is requesting consent forms to be mailed, this system is used to place the order
OES
Used when a requestor indicates they received a letter or call from Humana and are contacting us with the information we requested, or they want to understand next steps as results of the letter/call
Communication/Got a Letter/Call
How far in advance must a member schedule transportation to guarantee availability?
48 business hours
Member is pregnant, what benefits are we quoting
Baby and Me Meals- reference eligibility requirements
Convertible Car Seat or Portable Crib
Obstetrics
Rewards
Member is calling to learn more about their OTC benefits, what document would I use
OTC Benefit Medicaid Overview
Member needs to order a State Medicaid ID Card, what system will the card be ordered in?
CI
Used when members are requesting to update or dispute Medical Other Insurance information on file. The Other Insurance Template is required to be completed. Case must be routed to COB for investigation.
COB/ Medical Update/Dispute
Once RX Co-Payments go back into effect, what is the cost to members for prescriptions out of pocket?
Member is calling about weigh loss surgery, is this covered and if so what benefits are we quoting
yes- Bariatric Surgery
Member is calling to see if a wheelchair would be covered, what document/s would I use
Louisiana Covered DME Items
Verification of Benefits Calls Medicaid
Debut Benefit Tool Medicaid Overview
Member is calling due to a denied prescription at the pharmacy, what systems am I using?
CRM
Rx Nova Call Connect
Used for disenrollment or cancellation status questions or to request disenrollment or cancellation
Enrollment/Disenrollment
Does Humana require a pregnancy notification
Member calls in, states they have a broken arm, what benefits are we quoting?
Laboratory and Radiology Services
Ambulatory Surgical Center Services