Communications
Humana Communication methods include
Letters Forms and Outbound Voice Automated Technology VAT calls
Calls that require Humana materials to be sent to a member are considered to be??
Fulfillment Calls
When do you verify Demographics??
When the "days last verify shows 90 or more days.
What are the type of drugs do we have??
Brand & Generic
What are some e.g. of drug list humana wouldn't cover
Drugs used to treat anorexia, weight loss or weight gain.
Fertility drugs.
Drugs used for cosmetic purposes or hair growth.
Drugs used to treat erectile dysfunction.
Prescription vitamins and minerals.
Non-prescription over-the-counter drugs.
List two Intent that will follow communication
1. Got a Letter/Call
2. Smart Summary
3. Member Preference
4. Welcome Call
5. Unused Supplemental Benefits Overview
Which system is used to send out an ID Card??
ID Card Management
What is the C/I if the change was successful
Classification- Demographics
Intent- Change
What are the different tiers?
T1, T2, T3, T4, T5
What are the different types of coverage restrictions
Prior Auth, Step Therapy, Quantity Limits
Where do we access these letters??
RTI window
EMME
What is the C/I for this call type
Classification- Fulfillment
Intent- Benefit Information, ID Card Status, ID Card/ Access Card Request, Letter/Form Request Unassigned
What is the name of the document you will pull up for Demographics?
Demographics Changes for Medicare Members
Name the Drug Classification?
Maintenance, Controlled, Specialty & Compound
What are Non-Covered Medications??
Prescription not covered by Humana
What are some reasons a member might receive a VAT call?
Medication refills, automatic payment reminders, notifications of gaps in care, flu shot reminders
What is the TOT for the member to receive an ID Card?
5-7 Days
2wks the longest
For a Temporary address change what's the time limit the member have to stay at the address??
6 months
Which system is used to check benefit?
Rx Connect Pro
What is the name of the mentor document for Errors
Actions for RxNova Error Codes
True or False - A member will receive a Smart Summary if they did not have any claim activity in the month prior?
•False, only sent when the previous month had claim activity.
What's the difference between ID Card Management and ID Card Center
The ID Card Center is 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.
ID Card Management is the tool use to request the ID Card.
What if the member going to be at the new address longer than 7 months. What would you advise the member?
•Of their plan OSA timeframes. In this case, he could stay in Florida up to six months.
•Their plan terminates after being OSA past the timeframe.
•Have the member contact their agent or CMS (Centers for Medicare and Medicaid Services) to prevent a lapse in coverage.
Mentor Doc Temporary Address Changes for Medicare Members
Give 4 forms of Dosing forms and ex
Liters, Grams, milligram, milliliter
When the member state that their medication is lost or damage. What are some alternatives you can give to assist them with getting their medication