Wave 1
A member is past due if Humana hasn't received payment by the __________
1st of the month.
What happens when the member satisfies the MOOP?
Humana pay 100% for all covered services for the rest of the year.
The error code 080 stands for?
Refill too soon.
HCPR stands for?
Humana Clinical Pharmacy Review
Name the 3 allowances on the Humana Spending Account card.
Flex Allowance, Healthy options, OTC Allowance.
SSA deduction option is available as long their premium doesn't exceed what dollar amount?
$300
What is the name of the document used to check if a service requires an Authorization.
Pal List
What is the name given to the mentor document that is used to check error codes for denied claims in Rx Nova.
Actions for Rx nova error codes
What is the name given to the billing system used so members can enter their card information securely?
Secure Pay.
Who has the authority to obtain information on a deceased member's policy.
EOE- Executor Of Estate
How long does the Authentication code sent to the member last for?
20 minutes.
Under what benefit would a CT scan fall under.
Advanced Imaging Service
Name the 2 Cap types.
E- Easy to open
S -Safety (aka Child Proof)
What is the response to a CMS test call?
Yes.
What does CIT stand for?
Clinical Intake Team
How long can a member stay OSA (Outside the Service Area) of their Medical plan.
6 months.
How long does an Authorization take to be approved.
14 days.
What is duration for a Mail order Override?
5 days.
What is compound medication.
A medication that is made using more that 1 ingredient or a customized medication that includes multiple ingredients in the exact strength and dosage.
What is the SYSTEM used to send Id Cards by email.
Id card Center.
Once a member first becomes eligible for Medicare they have 63 days to enroll in a Part D plan.
Name 3 services that an Authorization is needed for.
Surgery, Advance Imaging, Home health.
eg. Knee surgery, MRI, CT scan
How long does the patent last before a generic drug can be made?
17- 20 years.
In detail what is the Smart Summary.
A Smart Summary is a monthly statement that is sent tot members to provide and overview of the claims that were processed in the previous month.
How long does it take for a member to appeal a denial of an Authorization or claim?
60 days.