General
If the provider calls requesting benefit and copayment information without the mbr on the line can we provide the info? If not what is the correct procedure?
NO we cannot, call needs to be transferred to the provider line. Number to transfer is 1390024.
If a mbr representative calls wanting to make a payment but the mbr is not on the line and we don't have any consent, can we take the payment and provide the amount information?
Yes we can take the payment but no we cannot provide the amount. They would have to say how much they would like to pay.
Name 5 things a mbr can do from the secure Myhumana.com site
1. Pay their bill
2. Change account settings
3. Block or Unblock communications
4. View Plan coverage details
5. Check claim status amd history
6. Chat with a CSR
7. Find in network physicians or pharmacies
8. Access Id Card and personal health records
What is the name of the document where we can see if a DME requires an authorization?
Humana Customer Care Pre Authorization and Notifications List (PAL)
What is the name of the procedure in which a mbr has already been denied an initial request for a drug coverage and they are unhappy with the outcome so they decide to ask for it to be reviewed again?
Redetermination
What are the Humana Pillars?
Agent Ease
Agent Helpful
Issue Resolution
Agent Care
Process Ease
How many RX Plans are offered for mbrs, what are their names? Mention name of mentor document.
3 Plans
a. Basic RX Plan
b. Premier RX Plan
c. Walmart Value RX Plan
Name the times it would be inappropriate to offer web self service options to a mbr? 4 items
1. Member is Irate
2. Member states they don't have access to a device.
3. Member suggest they are in a hurry.
4. Call is escalated to a supervisor
What key word would you use in Debut to find information about a knee replacement?
SURGERY
What options can we give the member if a medication is not covered? 4 items
1. Non Formulary exception request.
2. Good RX website
3. The Humana Community Navigator
4. Speak to PCP for alternate drugs
How would you explain to the mbr a split payment for medication in your own words?
Decision made by Dani for best response.
Are you the right person to answer questions about Humana Medicare and Medicaid plan Health Benefits?
What mentor document do we refer to?
Yes I am.
Mentor Document: CMS and Knowledge Test Calls
True or False: We use the Web emulation tool to change mbrs account settings and make payments for them so we avoid them getting angry.
FALSE: Web emulator is only used to guide the mbrs on how to do processes online.
What is the BIN and PCN Number, where do you find it and what mentor doc do you use?
BIN 015581
PCN: 03200000
Mentor DOC: Pharmacy claims overview.
How many times can a vacation override be submitted for a member? What is the name of the mentor document where you can find this information?
This can be submitted 2 times per year. The mentor document is: Pharmacy Vacation Overrides Overview.
Explain the meaning of TROOP in your own words.
Answer will be judged by Dani and Loren.
Name 5 preventive services offered by Humana.
1. Colonoscopy
2. Mammogram
3. PAP Smear
4. Colorectal Cancer Screening
5. Prostate Cancer Screening
What key item is required to log into CSR Password reset tool?
AKA Name
Name the documents and tools which can be used to provide information about medical benefits to mbr.
1. EOC: Evidence of Coverage
2. Summary of Benefits
3. Benefit Grid
Where can we check the stage that the mbr is currently in in RX nova?
Eligibility/Accumulators
What are the 8 steps for the call flow that we should follow according to our modules?
1. Greet
2. Show empathy
3. Understand Issue
4. Resolve Issue
5. Next Steps
6. Offer Additional Assistance
7. Recap
8. Close
What is the other name for Extra Help?
According to the correct Mentor doc what code is used for Level 4 LIS and what is the deductible, OOP for generics and preferred and any other drug for 2024?
What is the name of the Mentor Doc used?
LIS: Low Income Subsidy
Code: Level 4 Code 1001 Deductible $0.00/ OOP Limit $4.50 Generic or preferred/$11.20 for any other drug
Mentor Document: Extra Help LIS comparison
What is the name of the Mentor document that provides instructions on how to reset and login mobile apps that also provides screenshots.
Login and Password reset for mobile apps.
What are the 5 CRM abbreviation codes for the Plan Types handled by Individual Medicare?
1. MEP: Medicare Choice PPO
2. MER: Medicare Gold Plus/Gold Classic HMO
3. MRO: Medicare Gold Plus POS
4. MEF: Medicare Gold Choice PFFS
5. PDP: Prescription Drug Plan
Can a Tier 5 medication have a tier exception made? If yes or No please provide the complete name of the mentor document in which you can find the answer.
No, refer to mentor document: Medicare Tier Exception Request.