I
This period begins on 10/15 and ends on 12/07
What is Annual Election Period (AEP)?
The incoming call greeting.
What is "Thank you for calling Humana, my name is ----, how can I help today?"
This must be obtained BEFORE speaking with anyone besides the member or POA on file.
What is verbal consent?
This is known as the reason for any call.
What is Classification and Intent?
This must be done every 90 days for EVERY member.
What is Verify Demographics?
The most common denial code in RxNova.
What is code "080-Refill too soon"?
This tool is used to request prior authorizations.
What is PromptPA?
This is done when is a member does NOT want to receive automated calls.
What is add to Do Not Call (DNC) list?
This tool is used to document every call.
What is QuickStart+?
This tool is used to verify available benefits.
What is DEBUT?
This tool is used to view/print letters.
What is RTI?
A MAPD/PDP member can have up to 2 of these a year.
What is a Vacation Override?
This system allows agents to view/send ANOCs and EOCs
What is OMS?
If a member has claims, this is sent out every month.
What is a SmartSummary?
This document is used to determine if a HMO member needs a Prior Authorization.
What is the Humana Customer Care Prior Authorization and Notification List?
This is the Guidance Alert Delivery percentage.
What is 65%?
This is the Guidance Alert Adherence percentage.
What is 90%?
This RxStatus mean the prescription is able to be filled.
What is "Refillable"?
The 3 stages of pharmacy benefits.
What is
-Deductible
-Initial Coverage
-Catastrophic
This is known as the Maximum Out-of-Pocket amount (MOOP).
What is $2,100?
This CI screen shows the member's other coverage.
What is PEOC?
This CI code shows Effective Date, Termination Date, Benefit, Class, Plan/Option, Coverage Type, PCP
What is PAPI?
This RxNova code means A claim was already processed.
What is "023: Duplicate Claim"?
This mentor document shows just about every topic for a Medicare call.
What is the Individual Medicare Calls Document Index?
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