Phones
Your phone rings! You pick up the phone and say...
What is "Thank you for calling Humana's Home Solutions UM Team, my name is [Name & Title]. This call may be recorded for quality and training purposes. How may I help you?"
You're processing a denial for an HMO member. Who receives the denial letter?
What is Member, PCP, ordering MD and HHA unless PCP and ordering are same.
A Peer-to-Peer is offered to whom?
What is the Requesting Provider
An auth request comes in for 5 visits for G0299 SOC, how do you proceed with the request?
Auto Approve Request
A request is received for G0299x11 as a SOC. What should happen with the request?
Pend to Clinician
Member rep calls to get status of auth. What do you need?
What is POA or AOR
True or False- I should be checking my Fax Status every hour.
What is True
A doctors Medical Assistant calls to request to complete p2p themselves. Is this allowed?
What is No, only MD, PA, NP can complete a P2P.
WebIVR cases come in to this queue
What is Home Solutions UM
Authentication consist of which elements?
What is Member ID, date of birth and Provider NPI or Tax ID
You get a call from a provider and authenticate; you have member pulled up and provider states i want to verify member benefits. Where do you document?
What is member level notes
Does a Spanish Approval letter need to be sent to UMAC 3s for translation?
What is No
The P2P offer fails by Fax and Phone, and you are unable to reach HHA by phone. What goes on the denial template after all options have been exhausted?
what is Add No P2P/ HH Agency on Denial Template and update the P2P Tracker
A WebIVR comes through with overlapping dates and no hospital stays. Who do you call to verify the information received is correct?
what is Home Health agency
A fax request for a Oak Street Grouper comes to NLP. In the market guide what guidance is followed?
What is build/update the case and send to appropriate Oak Street Queue.
After receiving a call you can change your Avaya status to "After Call" to have time to document. How long can you stay in "After Call"?
What is 2 min
If a case is manually pended and stayed overnight in pending status, do we need an Approval Letter?
What is Yes we need to send an Approval Letter
A provider calls and wants to accept P2P after determination made. Where do you direct them to call?
What is Grievance and Appeals (G&A)
Where can a 485 be found for Centerwell cases?
What is in Homecare Homebase under orders.
What is on authorized units field when adding 5 visits to an approved authorization with 10 visits prior?
What is 10 visits
HHA calls in to request expedited review. What do you do?
What is explain only the member or member representative can request expedited review, notate the call on a comm rec and proceed with normal process
A case with day's aging 12 or more must be sent through which service?
what is Veritas
I have a WA member that I am offering P2P for it is now a day 12 at 2 pm. I offer p2p for 10 AM PST to call back, what goes into the next review comments?
what is CB by 1 PM EST
True or False: I have an Elara case that is pended per process. I send the case to the HSUM Legacy Clinician queue.
What is False
You receive a Conviva Grouper ID 84301402 which Conviva queue do we send this auth to?
What is none. We send this to the HSUM Legacy Clinician Queue.