Communication
What type of notifications does humana send out?
Letters
What does COB stand for?
Coordination of Benefits
What 3 things must you verify for authentication?
ID
Name
Zipcode
Where do you submit a request to care management?
CGX or GuidingCare
What systems do you use to mail out plan related material?
OMS/OES
Where can you find the history of letters sent to members?
RTI Button in CRM or EMME
Medicare always falls secondary to all other insurance companies.
True or False
False
What can you change for a member in CRM?
Phone number
Address
Email address
What is a Care Manager?
What is the name of Humana's Medicaid reward program?
Go365
Mass Mailings can be viewed within EMME.
True or False
False
What are the mentors for COB?
Both Medicare and Medicaid
Medicare COB Overview
Medicaid and MMP COB Overview
If on Medicaid where should members call after updating Demographics with Humana?
The State Dept.
When do you transfer to care staff?
When a care manager is on file for the member
What is the average turn around for an ID Card to arrive?
5-7 Business Days
What is the name of the form to release consent?
Consent for Release of Protected Health Information (PHI)
What must you fill out when updating other insurance in CRM?
Other Insurance Template
The Humana ID is considered Demographic information
True or False
True
What is the mentor for creating a task for care management in GuidingCare?
Create and Send a GuidingCare Activity
What is the difference between a Grievance and an Appeal?
Grievance: dissatisfaction about something other than claim or auth
Appeal: disputes claim or auth outcome
What is the name of the Audio substitute for print material?
Daisy
How many cases should you make when handling a COB pharmacy 090 denial in CRM?
2 Cases
1 for the update
1 for the denial
What do you do to update address in CI?
Create Task then update in next screen
What is the HRA called in Illinois and South Carolina?
Health Risk Screening for Illinois
Health Risk Assessment for South Carolina
Who can file a QAA Complaint?
Member
POA
Someone with an AOR