A
What is the allotted time frame for medical authorizations Non-Urgent and Urgent?
Urgent 72 Hrs.
Non urgent 7 Calendar Days
What tool do we use to check if a referral is required?
Referral Guidance Tool
The purpose of active listing is to_____
Understand
Which screen would we use to check Other Insurance in CI?
PEOC
What do you call the grievance that you log when a member is dissatisfied with their Provider/Treatment/Attitude?
QAA Complaint
Creating _______ of care, help us put care into action?
Moments
What is humana's standard greeting?
"Thank you for calling humana. My name is ___, Your healthcare advocate. How may I help you?
We should never give the member this on a call?
Homework :)
We should avoid these types of statements?
Negative
What is an affirmation?
Positive statements
If a member is AUTHENTICATED, what do you verify?
DOB and ZIP CODE
What is the Letter code in EMME for a consent form?
ME2427
What is reflective listening?
Repeat, Rephrase, Paraphrase
What is empathy?
Putting yourself in someone else's shoes
What are the humana values?
Caring, curious and committed
What does C.A.R.E.s stand for?
Connect, Appreciate, Respond, Empower
What type of callers does humana receive? 4 Examples
Member's, Member Reps, Providers, Agents
Where in CRM can you check if a member has a care manager on file?
Health Resources
When someone calls in regard to a deceased member, how do you disposition the alerts on file?
What is the purpose of reflective listening? 3 Examples
Reflective listening
Clear communication
Understanding
After setting up the members appointment what appointment details do you need to confirm to the member? 3 Examples
Doctors name and address
App date and time
Whether the member has transportation
Member says "It's so nice to have someone to talk to about this" what kind of need is the member expressing?
Social
Member says I can't get around like I used to anymore what type of need is the member expressing?
Physical
What does CAHPS stand for?
Consumer Assessment of Healthcare Providers and Systems
What are open ended questions?
Can not be answered with a yes or no
Requires an explanation or more Information