CI SCREENS
Where do you find the Sign date?
PAPI
two options for accesing disenrollment forms?
Forms can be mailed to the member and member can print forms from Humana.com
If the mbr stated that they wanted to be reinstated back onto their previous Humana Coverage, what will be the next step?
a. Type in the CRM Comments: "Member has requested cancellation of plan (contract/PBP/segment) and needs to be reinstated back onto the previous Humana Coverage. Sending to the Disenrollment Correspondence team to have plan keyed."
b. Transfer the case to
Service Center: Louisville
Department: Service Operations (RSO) Enrollment
Topics: Disenrollment/Cancel-Individual and Group Medicare Only.
Process if the members are calling after the end date?
a. Determine if the member has an SEP enrollment
b. Tell the caller:
The end date xx/xx/xxxx, after the plan has ended, you must speak with a licensed sales agent to re-enroll.
c. Transfer the call to DMS.
Process if the members are calling after the end date?
a. Determine if the member has an SEP enrollment
b. Tell the caller:
The end date xx/xx/xxxx, after the plan has ended, you must speak with a licensed sales agent to re-enroll.
c. Transfer the call to DMS.
Where do you find the Trans Stat Code?
PAIG
Mailing disenrollment forms is not an option the last 4 days of the month
True!
Mentor Document to know the prospect ERC.
Cancellation of Enrollment End Reason Codes for Calls.
You are going to be able to rekey after 10 p.m?
FALSE!
Process if the transmit status is 06/57?
a. Create a work task on the PATR screen
b. access the PAPM screen
c. Delete the end reason code from the End Reas field, and press F11
d. Is the transmit status now 02, if yes, access the PAPI screen and if the plan is active, manually generate and send the applicable letter:
MA/MAPD: ME0307
PDP: ME0317
Screen to verify of the plan is an OSB.
POSB
How do you determine if the member qualifies for an SEP?
By asking the SEP questions in the Mentor document "SEP Questionnaire for Medicare Disenrollment"
What is the next step for the Trans Stat if it is 01/51?
Follow Mentor
a. Pend the CRM case for up 3 days
b. When the Transmit Stat is updated to O2, make the process of cancellation.
c. If the Transmit status does not update after 4 days (the date of the call is day 1), transfer the CRM case to the following
Service Center: Louisville
Department: Retail Service Operations (RSO) Enrollment
Topic: Disenrollment/Cancel-Individual and Group Medicare Only.
METs for cancel cancellation
NONE
METs are not required.
METs for Cancellation of DE request
Mentor
Screen that is triggered by the PACT?
CITR
METs for Disenrollment.
Subtype: Disenrollment
1.
a. TASK: Disenrollment SEP letter needed.
b. ACTION: Disenrollment SEP letter generated
c. SOURCE: Letter Automation
2.
a. TASK: Request Denied
b. ACTION: CMS Guidelines
c, SOURCE: Humana Representative
METs for Cancellation fo Enrollment
the quick MET Processing C/E Verbally in the MET Entries Association field must be selected.
If manually entry is needed
1.
a. Task: Request Received
b. Action: Complete
c. Source: Inbound Call from Member
2.
a. Task: Updated Humana Systems
b. Actions: Completed
c. CI
3.
a. Closing Task
b. All Updates Completed
c. Humana Representative
Process if the Trans Stat if 27
a. Tell the caller:
-You have sent their request to keep their plan
-They will receive a confirmation letter in 7-10 days.
b. Type the following comment in CRM:
Member has requested to cancel their cancellation request of plan (contract/PBP/segment). Due to member having an open retro case, linking cases and sending to CPU for review.
c. Give them the CRM case number.
d. Select the appropiate C&Is.
e. Transfer the case to the following. The Procedure is complete.
Service Center: Louisville
Department Retail Service Operations (RSO) Enrollment
Topic: CMS Retroactive Processing - Individual and Gropu Medicare Only
Process if the transmit status is 08?
MENTOR
Screen you will find the Verification control number and will update the Premium Amount Chg Stat
PCRP
Steps to guide the member for a disenrollment request. Follow Mentor
1.Primary research in CRM, CI and MARx
2. Review if the plan is already termed in CI
3. Ask the SEP questions if is not given automatically, recall if you heard any sales allegation violation language from the caller.
4. Review the last 4 business days of the month, provide the urgent fax number, or email
5.provide the written request and how they can submit
6. If applicable, provide the other method to submit their request.
7. Provide Case number.
Step by step of the cancellation of enrollment in CI
1. Select the proper policy
2. Go to PAIG: to review the trans stat code (workable/non workable)
3. PAPI
4.Create task-PATR
5. PAPI
6. PACT: field the request information
7. CITR: CRM and Tracking ID
8. PAIG: Trans Stat: 47
9. PCCV: STA
Process of cancel cancellation when the trans sat is 38
a. Create a work task on PATR screen.
b. Access the PAIN screen and rekey the coverage.
c. obtained before rekeying, as information is cleared after rekeying.
Enroll Spurce: The orgiinal enrollment source found on the PAIG screen.
New Indiv Agrmnt: the 3-digit BSN listed on the previously nulled plan from PAPI
Cov Eff Dt: the plan effective date
PCP ASG: found on PAMG
PCP Provider ID: For MA or MAPD plans, found on PAPI
Sign Dt: the original signature date from PAPI
Market Stamp Dt: The Market Stamp Date from the PAIG Screen
Transmit Stat:04
CMS Enrl Src: Original CMS Enrl Src found on the PAIG screen
Press F11
d. Access the PAIE screen and update
Market Source: 54
ETC: original ETC
Selling agt SSN: selling agent's SSN
Eff Dt: the plan effective date
Press F11
Access the PAPI screen
e. if the plan is active on the PAPI screen, manually generate and send the applicable letter
MAPD/MA: ME0307
PDP: ME0317
Why are METs created?
To generated milestone, tracking Id
Basically, tells a story.