I
This period begins on 10/15 and ends on 12/07
What is Annual Election Period (AEP)?
This is known as the Incoming Call Greeting
What is "Thank you for calling Humana. My name is ----, how can I help today?"
This must be obtained BEFORE speaking with anyone besides the member or POA on file.
What is Verbal Consent?
This is known as the reason for any call.
What is Classification and Intent?
This is done when a member does NOT want to receive automated calls.
What is add to Do Not Call (DNC) list?
The most common denial code in RxNova.
What is 080-Refill too soon?
This tool is used to request prior authorizations.
What is PromptPA?
Must be done every 90 days for EVERY member.
What is Verify Demographics?
This common tool is used to document every call.
What is QuickStart+?
This tool is used to verify available benefits.
What is DEBUT?
This tool is used to view/reprint letters.
What is RTI?
A member can have 2 of these a year.
What is a Vacation override?
This system is used to verify medication coverage
What is RxConnect?
If a member has claims, this is sent every month.
What is a SmartSummary?
The 3 stages of pharmacy benefits.
What is
-Deductible
-Initial Coverage
-Catastrophic
This RxStatus means the prescription has never been filled.
What is "NewRx"?
These 2 claim codes mean the prescription was approved and paid for.
What is 10PAY/11PAY?
The 4 phases of the call flow.
What is the Opening Phase, Issue Identification Phase, Resolution Phase, and Closing Phase?
The guidance alert adherence percentage.
What is 90%?
The Guidance alert delivery percentage.
What is 65%?
This CI screen shows the member's other coverage.
What is the PEOC screen?
This CI code shows Effective Date, Termination Date, Benefit, Class, Plan/Option, Coverage Type, PCP
What is PAPI?
This Rx code means "The cost is more than the maximum allowed."
What is 013: Ingredient Cost Greater Than Allowed By Plan?
This mentor document shows just about every topic for a Medicare call.
What is the Individual Medicare Calls Document Index?
This is the BESTEST trainer ever!
Who is Mikki? :)