BILLING
True or False Partial payments alone will not prevent fro terminating
True
What form of payment is only accepted by humana
credit cards with visa,mastercard,discover american express
Which tier is usually preferred and least expensive
Tier 1
This tool is used to verify member benefits
What is Debut
Authorization process
What is a clinical review for determination coverage
which tool is used to access member billing profile
ebilling
what system should you access on each call
mentor
This system is used to research claims
What is RXNOVA
This tool is used to help member check to see if a provider is in network
physician finder
If preauthorization is not required you must still determine if this is required
referral
Which plan usually have a 3 month grace period
PDP
this law governs the exchanging of personal information
Hippa
Blank drugs are typically high cost medications that are not commonly stocked at a pharmacy
Specialty drugs
blank services are services provided by a primary care physician or a specialist and cover a wide array of services
Physician
What are the status for a authorization
approved,denied,partially denied,pending,voided
A member is consider late/ past due when a payment is not received by the blank of each month
15 of each month
Advocate are required to show this on every call
empathy
Blank is the amount a member pays for their covered medical costs within a plan year.
What is Maximum Out Of Pocket (MOOP)
Which plan doesn't require members to have a pcp
ppo
This authorization is requested after the medical services, treatment and test have been received
retrospective authorization
LEP can be assessed if the initial enrollment period for the member has ended and they have gone blank consecutive days without creditable drug coverage
63 days
what should be verify on every call
demographics
Maximize Your Benefits(MYB)
Black service is when a patient is admitted and spends at least one night sometimes more depending on the condition under the care of doctors,nurses, and other health care professionals.
inpatient
Whats used to determine whether a medical service requires preauthorization and who manages the preauthorization
humana customer care preauthorization and notification list (PAL)